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Individual
JENNIFER ROSE PETERSON
Active
Individual
JENNIFER ROSE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC189963
OR
225700000X
Massage Therapist
20187
OR
Other
Enumeration date
01/30/2019
Last updated
01/30/2019
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