Individual
MR. LARRY L PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
601 S EDWIN C MOSES BLVD, DAYTON, OH 45417-3424
(937) 734-8333
Mailing address
1716 SALEM AVE, SPRINGFIELD, OH 45505-4348
(937) 536-7636
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
378059
OH
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
RN.378059
OH
163WH0200X
Home Health Registered Nurse
378059
OH
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
378059
OH
Other
Enumeration date
12/02/2013
Last updated
10/02/2019
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