Individual
KENT PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1604 VISA DR STE 1, NORMAL, IL 61761-2195
(309) 846-4716
(409) 454-1107
Mailing address
1604 VISA DR STE 1, NORMAL, IL 61761-2195
(309) 846-4716
(409) 454-1107
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041300994
IL
Other
Enumeration date
01/22/2009
Last updated
01/22/2009
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