Individual
STEPHANIE LYNN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0100
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
22348
SC
363LF0000X
Family Nurse Practitioner
AP60633476
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2038729
—
WA
05
—
500672839
—
OR
Enumeration date
02/22/2010
Last updated
11/28/2018
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