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Individual

MS. ANN PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
2 DALY RD, MEDFORD, MA 02155-3702
(781) 393-8833
Mailing address
2 DALY RD, MEDFORD, MA 02155-3702
(781) 393-8833

Taxonomy

Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
046055-21
NH
163WG0000X
General Practice Registered Nurse
067490
CT
163WG0000X
General Practice Registered Nurse
Primary
RN86754
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
046055-21
STATE LICENSE
NH
01
067490
STATE LICENCE
CT
01
RN86754
STATE LICENCE
MA
Enumeration date
07/12/2012
Last updated
07/12/2012
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