Individual
STACY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9811 W CHARLESTON BLVD # 2-641, LAS VEGAS, NV 89117-7528
(855) 864-4322
(866) 540-8267
Mailing address
1571 PLAZA CENTRE DR, LAS VEGAS, NV 89135-3408
(225) 571-6079
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
10/22/2019
Last updated
10/22/2019
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