Individual
MR. KENNETH S PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
70 HIGHLAND ST STE 1, WORCESTER, MA 01609-2730
(508) 715-6372
Mailing address
70 HIGHLAND ST STE 1, WORCESTER, MA 01609-2730
(508) 847-6546
(508) 433-9785
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN192039
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0322938
—
MA
Enumeration date
07/19/2006
Last updated
08/27/2024
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