Individual
INGRID PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
707 GUM ROCK CT, NEWPORT NEWS, VA 23606-2523
(757) 873-2273
Mailing address
PO BOX 2546, VIRGINIA BEACH, VA 23450-2546
(757) 340-3489
(757) 340-4278
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
0704015731
VA
Other
Enumeration date
04/25/2023
Last updated
04/25/2023
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