Individual
MR. BYRON JAMES PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-1000
Mailing address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-1000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024170570
VA
Other
Enumeration date
11/02/2012
Last updated
12/23/2020
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