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Individual

SUSAN R PETERSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
237 26TH ST, OGDEN, UT 84401-3105
(801) 625-3700
Mailing address
237 26TH ST, OGDEN, UT 84401-3105
(801) 625-3700

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
177248-3102
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
260022408
RAILROAD MEDICARE
UT
05
876000308007
UT
Enumeration date
03/25/2008
Last updated
05/05/2008
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