Individual
LIDIA TIMOFEENKO PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
972 SUGAR SPRINGS DR, LAS VEGAS, NV 89110-2936
(208) 410-3048
Mailing address
972 SUGAR SPRINGS DR, LAS VEGAS, NV 89110-2936
(208) 410-3048
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
53260
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
835379
NV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
TEMP53260
ID
Other
Enumeration date
06/29/2020
Last updated
09/06/2022
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