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NPI Code Detail

MEDICARE: MS. MARION ELISE PETERS

MEDICARE: MS. MARION ELISE PETERS
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1275353922
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARION ELISE PETERS
Provider Business Mailing Address
First Line : 80 PLACER HILL DR
Second Line :
City : JACKSONVILLE
State : OR
Zip : 97530-9380
Country : US
Telephone Number : 503-310-4120
Fax Number :
Provider Business Practice Location Address
First Line : PO BOX 1257
Second Line :
City : PHOENIX
State : OR
Zip : 97535-1257
Country : US
Telephone Number : 541-535-5458
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2024
Last Update Date : 10/16/2024

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Directions to “ MS. MARION ELISE PETERS ” Practice Location

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