MEDICARE: JANE M PETERSON APN

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	163W00000X	Registered Nurse	RN196717	OH
2	363LW0102X	Women's Health Nurse Practitioner	COA.02264.NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427378728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE M PETERSON APN

Provider Business Mailing Address
First Line	:	7997 EUCLID AVENUE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-4226
Country	:	US
Telephone Number	:	216-851-1880
Fax Number	:	216-707-9370

Provider Business Practice Location Address
First Line	:	7997 EUCLID AVENUE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-4226
Country	:	US
Telephone Number	:	216-851-1880
Fax Number	:	216-707-9370

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

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	09/18/2014

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