Individual
EDITH C PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1424 GENESEE ST, UTICA, NY 13502-5101
(315) 724-6146
(315) 797-9671
Mailing address
1040 STATE ST, SCHENECTADY, NY 12307-1508
(518) 374-5353
(518) 347-1413
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
371556
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F-302355
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
346874
MVP
NY
Enumeration date
10/04/2006
Last updated
03/07/2023
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