Individual
MS. ADRIANE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1450 MAIN ST, WEAVERVILLE, CA 96093-1099
(530) 623-1362
Mailing address
PO BOX 1640, WEAVERVILLE, CA 96093-1640
(530) 623-1362
(530) 623-1447
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53
—
CA
Enumeration date
06/08/2022
Last updated
09/05/2024
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