Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP139785 | TX |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 107046 | OK |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP139785 | TX |
NPI | 1275002305 |
---|---|
Provider Name | Leah Dianne Peterson |
First Address | Tulsa, OK 74104-4012 |
Second Address | Tulsa, OK 74104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2018 |
Last Update Date | 01/11/2019 |