Individual
MS. PATRICIA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7836 W JEFFERSON BLVD STE 101, FORT WAYNE, IN 46804-4178
(290) 494-3484
(290) 969-0188
Mailing address
7836 W JEFFERSON BLVD STE 101, FORT WAYNE, IN 46804-4178
(260) 494-3484
(260) 959-0388
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
71008435A
IN
Other
Enumeration date
10/04/2018
Last updated
10/01/2020
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