Individual
PHYLLIS G PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
103 DR. BOWEN ST., BELLE CHASSE, LA 70037
(504) 392-3392
(504) 392-3303
Mailing address
103 DR. BOWEN ST., BELLE CHASSE, LA 70037
(504) 392-3392
(504) 392-3303
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
2065
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2065
2065
LA
05
—
2364693
—
LA
Enumeration date
05/30/2012
Last updated
06/13/2014
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