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NPI Code Detail

MEDICARE: NEFERTITI H PETERSON RN

MEDICARE: NEFERTITI H 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
1163W00000XRegistered Nurse303387OH

General Provider Information

NPI Number : 1689884843
Entity Type Code : Individual
Provider Name (Legal Business Name) : NEFERTITI H PETERSON RN
Provider Business Mailing Address
First Line : 3783 FAIROAKS RD
Second Line :
City : SOUTH EUCLID
State : OH
Zip : 44121-1922
Country : US
Telephone Number : 216-382-5622
Fax Number :
Provider Business Practice Location Address
First Line : 3783 FAIROAKS RD
Second Line :
City : SOUTH EUCLID
State : OH
Zip : 44121-1922
Country : US
Telephone Number : 216-382-5622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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