MEDICARE: YVONNE 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	164W00000X	Licensed Practical Nurse	PN281488	PA

General Provider Information

NPI Number	:	1871006999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE PETERSON

Provider Business Mailing Address
First Line	:	3884 EAST ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15214-2029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3884 EAST ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15214-2029
Country	:	US
Telephone Number	:	412-231-7866
Fax Number	:

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

Provider Enumeration Date	:	11/10/2017
Last Update Date	:	11/10/2017

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Directions to “ YVONNE PETERSON ” Practice Location

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