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NPI Code Detail

MEDICARE: HEATHER PETERSON RD, LMNT

MEDICARE: HEATHER PETERSON RD, LMNT
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
1133V00000XRegistered Dietitian609NE

General Provider Information

NPI Number : 1366529059
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER PETERSON RD, LMNT
Provider Business Mailing Address
First Line : 706 LINCOLN AVE
Second Line :
City : SHELTON
State : NE
Zip : 68876-9607
Country : US
Telephone Number : 308-647-6738
Fax Number :
Provider Business Practice Location Address
First Line : 2116 W FAIDLEY AVE
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68803-4645
Country : US
Telephone Number : 308-398-6540
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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Directions to “ HEATHER PETERSON RD, LMNT” Practice Location

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