Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 2001005092 | MO |
Y | 111NN1001X | Nutrition | T-03462 | KS |
NPI | 1194076281 |
---|---|
Provider Name | Faith E Peterman |
First Address | Shawnee, KS 66216-2740 |
Second Address | Shawnee, KS 66216-2740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2012 |
Last Update Date | 28/09/2012 |