Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 205602 | MA |
NPI | 1003877911 |
---|---|
Provider Name | Karen E. Peterson |
First Address | Rutland, MA 01543-1374 |
Second Address | Leominster, MA 01453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 20/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0325601 | (05) | MA |
P67093 | (02) | MA |