Individual
JOHN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NREMT
Contact information
Practice address
720 ESKENAZI AVE, INDIANAPOLIS, IN 46202-5187
(317) 880-0000
Mailing address
9500 FAIRFAX BLVD APT 2521, FAIRFAX, VA 22031-2450
(912) 662-9901
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
768753
TX
163W00000X
Registered Nurse
1224179
TX
163WE0003X
Emergency Registered Nurse
Primary
1224179
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/14/2025
Last updated
02/03/2026
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