Individual
KRISTEN MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
564 BURNSIDE DR, TIPP CITY, OH 45371-3711
(937) 838-5492
Mailing address
4927 WOODMAN PARK DR APT 6, DAYTON, OH 45432-1136
(937) 838-5492
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
400705210108
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0211289
—
OH
Enumeration date
05/16/2017
Last updated
05/16/2017
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