Individual
JEAN MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
STONY BROOK MEDICINE, HSC DEPT OF UROLOGY ROOM 040 LEVEL 9, STONY BROOK, NY 11794-8093
(631) 444-6270
(631) 444-6204
Mailing address
120 DIVISION AVE, WEST SAYVILLE, NY 11796-1303
(631) 750-1523
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
307876
NY
Other
Enumeration date
08/03/2016
Last updated
04/06/2017
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