Individual
JADE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
123 N WACKER DR, SUITE 1250, CHICAGO, IL 60606-1743
(800) 744-5962
Mailing address
43 LOTUS LN, SANFORD, NC 27332-0600
(678) 910-2952
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36-3644185
RETROFIT, INC
IL
Enumeration date
11/23/2016
Last updated
11/23/2016
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