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Individual
PAULA M PETERSON
Active
Individual
PAULA M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
504482
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
092104102
GROUP MEDICAID/TPI
TX
01
—
092104103
GROUP EPSDT
TX
01
—
1578514535
GROUP NPI NUMBER
TX
01
—
45D0703080
GROUP CLIA
TX
01
—
F057
GROUP MEDICARE
TX
01
—
TXB110627
GROUP MEDICARE PIN
TX
Enumeration date
08/11/2006
Last updated
09/16/2011
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