Individual
JULIE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
910 AVENUE F, GOTHENBURG, NE 69138-2060
(308) 539-4066
Mailing address
910 AVENUE F, GOTHENBURG, NE 69138-2060
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CPSS-256
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CPSS-256
—
NE
Enumeration date
10/30/2023
Last updated
10/30/2023
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