Individual
TIANA BROOKE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4600 VALLEY RD STE 200, LINCOLN, NE 68510-4882
(402) 483-4571
Mailing address
4600 VALLEY RD STE 200, LINCOLN, NE 68510-4882
(402) 483-4571
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9288
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9288
DHHS- TEP
NE
Enumeration date
06/13/2022
Last updated
06/13/2022
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