Individual
DR. KEITH HJALMAR JUDE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
77 PARK AVE APT 127, HOBOKEN, NJ 07030-7106
(973) 931-2812
Mailing address
77 PARK AVE APT 127, HOBOKEN, NJ 07030-7106
(973) 931-2812
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR17689800
NJ
363LA2100X
Acute Care Nurse Practitioner
Primary
26NJ01064600
NJ
Other
Enumeration date
08/03/2020
Last updated
11/26/2020
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