Individual
RONALD KYLE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 MEDICAL CENTER BOULEVARD, WINSTON-SALEM, NC 27103
(336) 716-2011
Mailing address
180 ROLLING MEADOW LN, CLEMMONS, NC 27012-6744
(770) 842-9916
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
280909
NC
Other
Enumeration date
10/02/2017
Last updated
06/16/2018
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