Individual
MR. SCOTT S PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1165
Mailing address
419 RAKOV RD, MAYBROOK, NY 12543-1157
(845) 421-7475
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
551523
NY
Other
Enumeration date
05/04/2021
Last updated
05/04/2021
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