Individual
TAWNI PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
205 N BERKLEY ST, COUNCIL, ID 83612
(208) 250-0970
Mailing address
PO BOX 560, NEW MEADOWS, ID 83654-0560
(209) 825-0097
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N-45114
ID
363LP2300X
Primary Care Nurse Practitioner
Primary
54458
ID
Other
Enumeration date
02/24/2016
Last updated
03/16/2017
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