Individual
DENISE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
524 23RD ST APT 3, ROCK ISLAND, IL 61201-8934
(309) 433-5760
Mailing address
524 23RD ST APT 3, ROCK ISLAND, IL 61201-8934
(309) 433-5760
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
P36216067618
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147733117
—
IL
Enumeration date
02/10/2017
Last updated
02/10/2017
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