Individual
KELLI ANN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7822 DAVENPORT STREET, OMAHA, NE 68114-3629
(402) 391-4855
(402) 391-6818
Mailing address
7822 DAVENPORT STREET, OMAHA, NE 68114-3629
(402) 391-4855
(402) 391-6818
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25596
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
094951017
WPS MEDICARE
NE
Enumeration date
04/13/2007
Last updated
10/28/2016
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