Individual
JERROD R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
19 LAKES STREET, NESPELEM, WA 99155-0071
(509) 634-2900
(509) 634-2945
Mailing address
PO BOX 71, NESPELEM, WA 99155-0071
(509) 634-2900
(509) 634-2945
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R32809
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7139470
—
WA
05
—
7139660
—
WA
Enumeration date
07/23/2013
Last updated
07/23/2013
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