Individual
PAMELA TERESA PETERSON
Active
Individual
PAMELA TERESA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704194081
MI
363LA2100X
Acute Care Nurse Practitioner
Primary
4704194081
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255371530
—
MI
01
—
P00252787
RR MEDICARE
MI
Enumeration date
06/07/2006
Last updated
09/08/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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