Individual
MRS. MARLA JEAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
267 GRANT ST, BRIDGEPORT HOSPITAL, BRIDGEPORT, CT 06610
(203) 384-3801
(203) 384-4619
Mailing address
91 ARTHUR ST, BRIDGEPORT, CT 06605
(303) 906-3675
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
077722
CT
367500000X
Certified Registered Nurse Anesthetist
077722
CT
367500000X
Certified Registered Nurse Anesthetist
Primary
080137
CT
Other
Enumeration date
10/08/2008
Last updated
12/02/2009
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