Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 1352084082 | KS |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 45355 | KS |
N | 363LW0102X | Nurse Practitioner - Women's Health | 44247 | KS |
NPI | 1013070390 |
---|---|
Provider Name | Joann M Peterson |
First Address | The Woodlands, TX 77387-9418 |
Second Address | Kansas City, KS 66160-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |