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NPI Code Detail

MEDICARE: LINDSAY RAE PETERSEN

MEDICARE: LINDSAY RAE PETERSEN
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
1237700000XHearing Instrument Specialist2931IL

General Provider Information

NPI Number : 1871115139
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDSAY RAE PETERSEN
Provider Business Mailing Address
First Line : 439 S MAIN ST
Second Line :
City : SENECA
State : IL
Zip : 61360-9437
Country : US
Telephone Number : 815-674-9997
Fax Number :
Provider Business Practice Location Address
First Line : 9500 JOLIET RD
Second Line :
City : HODGKINS
State : IL
Zip : 60525-4137
Country : US
Telephone Number : 469-503-0112
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2020
Last Update Date : 05/09/2020

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Directions to “ LINDSAY RAE PETERSEN ” Practice Location

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