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Individual

MARY K PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
451 STATE ST, NORTH HAVEN, CT 06473-3070
(203) 248-8888
(860) 621-5169
Mailing address
451 STATE ST, NORTH HAVEN, CT 06473-3070
(203) 248-8888
(860) 621-5169

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
000666
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000666
STATE OF CT LICENSE #
Enumeration date
02/27/2007
Last updated
05/19/2021
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