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Individual

MRS. ANITA PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
975 E. THIRD ST, CHATTANOOGA, TN 37403-2147
(423) 778-7806
(423) 778-2360
Mailing address
PO BOX 11225, CHATTANOOGA, TN 37401-2225
(423) 892-5602
(423) 892-5838

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN112460
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APN10854
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000926373A
GA
05
009968920
AL
05
1512360
TN
01
4026811
BLUE CROSS BLUE SHIELD TN
TN
01
430075451
RAILROAD MEDICARE
TN
05
8052326
NC
01
N445621
WELLCARE (GA MEDICAID)
GA
Enumeration date
11/26/2006
Last updated
08/21/2024
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