Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1780766691 |
---|---|
Provider Name | Ms. Debra Shereta Peterson |
First Address | Newport News, VA 23609 |
Second Address | Newport News, VA 23602-6414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |