Individual
CHRISTINE CANNER PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.P.N.
Contact information
Practice address
5590 KIETZKE LN, RENO, NV 89511-3019
(775) 323-2080
(775) 323-8216
Mailing address
5590 KIETZKE LN, RENO, NV 89511-3019
(775) 323-2080
(775) 323-8216
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN000661
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002416125
—
NV
01
—
880167036A017
TRICARE
NV
01
—
CC2388
BLUE CROSS BLUE SHIELD
NV
Enumeration date
07/14/2006
Last updated
08/15/2019
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