Individual
LORI ANNELLE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
104 ANGIE ST, RICEBORO, GA 31323-3016
(904) 251-5008
Mailing address
104 ANGIE ST, RICEBORO, GA 31323-3016
(904) 251-5008
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN168089
GA
163W00000X
Registered Nurse
RN9213978
FL
Other
Enumeration date
04/24/2012
Last updated
04/24/2012
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