Individual
MRS. PENNY LU PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3730 STATE ROUTE 21, WAYLAND, NY 14572-9727
(585) 534-5170
Mailing address
3730 STATE ROUTE 21, WAYLAND, NY 14572-9727
(585) 534-5170
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
273148-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02682171
—
NY
Enumeration date
06/18/2007
Last updated
07/09/2007
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