Individual
ALEXIS RAE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
356 MAIN STREET ER, RANDOLPH, NY 14772-9696
(315) 746-0303
Mailing address
356 MAIN STREET ER, RANDOLPH, NY 14772-9696
(315) 746-0303
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
339981
NY
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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