# PHYLLIS G PETERSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1366703019
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | 2065 | LA | Yes |

## Other

- **Enumeration date:** 05/30/2012
- **Last updated:** 06/13/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2065 | 2065 | LA |
| 05 | — | 2364693 | — | LA |