Individual
JERIANN C PETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7555 ENCHANTED HILLS BLVD NE STE 104, RIO RANCHO, NM 87144-8625
(505) 771-9833
Mailing address
1217 IGUANA RD SW, RIO RANCHO, NM 87124
(505) 785-7521
(629) 899-8684
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2005021426
MO
163W00000X
Registered Nurse
53068
NM
363LF0000X
Family Nurse Practitioner
2005021426
MO
363LF0000X
Family Nurse Practitioner
Primary
53068
NM
363LP2300X
Primary Care Nurse Practitioner
2005021426
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639405434
—
IL
05
—
1639405434
—
MO
Enumeration date
10/29/2009
Last updated
09/18/2023
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