Individual
JACOB MARK PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19434 COUNTY ROAD P31, BLAIR, NE 68008-5548
(402) 237-7638
Mailing address
19434 COUNTY ROAD P31, BLAIR, NE 68008-5548
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
02/19/2025
Last updated
02/19/2025
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