Individual
DANIEL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
470 E 3900 S STE 200, SALT LAKE CITY, UT 84107-2332
(801) 747-2800
Mailing address
470 E 3900 S STE 200, SALT LAKE CITY, UT 84107-2332
(801) 747-2800
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10366644-8900
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055266
MEDICARE PIN
UT
01
—
260022408
RAILROAD MEDICARE
UT
05
—
8760003008007
—
UT
Enumeration date
04/12/2023
Last updated
11/28/2023
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