Individual
PATRICIA GAIL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 266-4000
Mailing address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-1000
Taxonomy
Speciality
Code
Description
License number
State
163WX0002X
High-Risk Obstetric Registered Nurse
Primary
28157874A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28157874A
REGISTERED NURSE
IN
Enumeration date
10/17/2022
Last updated
10/17/2022
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