Individual
ELLEN TANNER PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CPNP, MSN
Contact information
Practice address
280 W MACARTHUR BLVD, OAKLAND, CA 94611-5642
(510) 752-6779
(510) 752-7836
Mailing address
15 HARTE AVE, SAN RAFAEL, CA 94901-5221
(415) 485-0783
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
333228
CA
Other
Enumeration date
01/08/2007
Last updated
01/03/2022
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