Individual
JAMIE D PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
1604 VISA DR STE 2, NORMAL, IL 61761-2195
(309) 846-4716
Mailing address
1604 VISA DR STE 2, NORMAL, IL 61761-2195
(309) 846-4716
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Enumeration date
09/24/2012
Last updated
09/24/2012
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