Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | IA |
NPI | 1114558426 |
---|---|
Provider Name | Melanie Elizabeth Peterson |
First Address | Wilton, IA 52778-9210 |
Second Address | Wilton, IA 52778-9210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2020 |
Last Update Date | 27/01/2020 |