Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 01073456 | IN |
Y | 2080P0214X | Pediatric Pulmonologist | 01073456 | IN |
NPI | 1316152127 |
---|---|
Provider Name | Stacey L. Peterson-Carmichael |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 06/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201216170 | (05) | IN |
948810 | (02) | NC |