Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 225351 | TN |
N | 363LG0600X | Nurse Practitioner - Gerontology | 225351 | TN |
NPI | 1013482454 |
---|---|
Provider Name | Rita F Peters |
First Address | Indian Mound, TN 37079-5403 |
Second Address | Indian Mound, TN 37079-5403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2018 |
Last Update Date | 12/10/2018 |