Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024169615 | VA |
NPI | 1003169053 |
---|---|
Provider Name | Neil Peterson |
First Address | Charlottesville, VA 22908-0816 |
Second Address | Charlottesville, VA 22908-0816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2012 |
Last Update Date | 16/10/2012 |