Individual
KELLI ANN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
73265 CONFEDERATED WAY, PENDLETON, OR 97801
(541) 966-9830
Mailing address
1011 SW 30TH, PENDLETON, OR 97801
(541) 310-9100
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
200843278RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171037
—
OR
Enumeration date
01/30/2009
Last updated
01/30/2009
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