Individual
TRAVIS DALE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-7414
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
8058003-4405
UT
Other
Enumeration date
04/15/2022
Last updated
02/17/2026
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