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Organization
UNITED STATES AIR FORCE
Active
Organization
UNITED STATES AIR FORCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATTI JO PETERSON-BALLIET CPNP (PEDIATRIC NURSE PRACTITIONER)
(626) 536-4774
Entity
Organization
Contact information
Practice address
7219 N LITCHFIELD RD, LUKE AFB, AZ 85309-1529
(623) 856-9725
(623) 856-7567
Mailing address
2407 N 127TH LN, AVONDALE, AZ 85323-6576
(623) 536-4774
(623) 856-7567
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
RN114749
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN114749
NURSING LICENSE
AZ
Enumeration date
08/25/2005
Last updated
08/22/2020
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