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NPI Code Detail

MEDICARE: MRS. JOYCE SHIRLEY PETERSON RN

MEDICARE: MRS. JOYCE SHIRLEY PETERSON RN
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1578682332
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOYCE SHIRLEY PETERSON RN
Provider Business Mailing Address
First Line : 56 WILSON AVE
Second Line :
City : CHADWICK
State : IL
Zip : 61014-9361
Country : US
Telephone Number : 815-684-5428
Fax Number :
Provider Business Practice Location Address
First Line : 125 S 4TH ST
Second Line :
City : OREGON
State : IL
Zip : 61061-1609
Country : US
Telephone Number : 815-732-3157
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/08/2007

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