MEDICARE: MADDISON J PETERSON

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	F09251161	UT

General Provider Information

NPI Number	:	1427922186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADDISON J PETERSON

Provider Business Mailing Address
First Line	:	2028 S 4140 W
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-6000
Country	:	US
Telephone Number	:	801-695-7670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1756 W ANTELOPE DR
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-1143
Country	:	US
Telephone Number	:	801-773-4840
Fax Number	:

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

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/06/2025

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Directions to “ MADDISON J PETERSON ” Practice Location

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