Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 099.0134092 | VT |
NPI | 1093331126 |
---|---|
Provider Name | Dr. Jessica Lynn Peterson |
First Address | Saint John, IN 46373-9150 |
Second Address | Dyer, IN 46311-1926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2020 |
Last Update Date | 24/06/2020 |