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Individual

LINDA MARIE PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
202 SANDPIPER DR, PORTLAND, TX 78374-4101
(361) 777-0282
Mailing address
202 SANDPIPER DR, PORTLAND, TX 78374-4101
(361) 777-0282

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
650620
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
82322U
BLUE
TX
Enumeration date
06/10/2005
Last updated
03/20/2008
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