MEDICARE: SYLINA PETERSON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	80825	NM

General Provider Information

NPI Number	:	1033930136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLINA PETERSON FNP-C

Provider Business Mailing Address
First Line	:	3964 PACIFIC LOOP
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-0831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3964 PACIFIC LOOP
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-0831
Country	:	US
Telephone Number	:	575-635-1403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/21/2024

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