Individual
DENISE K PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
11234 ANDERSON ST, #1617, LOMA LINDA, CA 92354-2804
(909) 558-8591
Mailing address
PO BOX 10427, SAN BERNARDINO, CA 92423-0427
(909) 558-8591
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP12031
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN566951
—
CA
Enumeration date
07/18/2006
Last updated
07/08/2007
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