Individual
NICOLE M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
611 W PARK ST, ED, URBANA, IL 61801-2500
(217) 383-3313
(217) 383-4014
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003809
IL
Other
Enumeration date
10/08/2010
Last updated
03/22/2016
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