Individual
JOY ELLEN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
6065 S FASHION BLVD STE 255, MURRAY, UT 84107-5403
(801) 467-4210
Mailing address
6065 S FASHION BLVD STE 255, MURRAY, UT 84107-5403
(801) 467-4210
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11003295-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11003295-4405
STATE OF UTAH DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING
UT
01
—
13860695-0151
STATE OF UTAH DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING
UT
Enumeration date
06/22/2021
Last updated
04/17/2024
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