Individual
RILEY WAYNE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
1055 N 500 W BLDG A, PROVO, UT 84604-3305
(801) 812-5033
(801) 812-5034
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5202116-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5202116-4405
UT
Other
Enumeration date
07/10/2020
Last updated
11/27/2023
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