Individual
MARY E PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
901 W BEN WHITE BLVD, AUSTIN, TX 78704-6903
(512) 816-8611
(512) 816-6171
Mailing address
901 W BEN WHITE BLVD, AUSTIN, TX 78704-6903
(512) 816-8611
(512) 816-6171
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP2970
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308127
—
AZ
Enumeration date
02/12/2008
Last updated
12/13/2016
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