Individual
MICHELLE E PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CS, FNP
Contact information
Practice address
1608 E EVERGREEN ST, SUITE A, CAMERON, MO 64429-2400
(816) 632-5424
(816) 632-7094
Mailing address
1600 E EVERGREEN ST, PO BOX 557, CAMERON, MO 64429-2400
(816) 632-2101
(816) 649-3383
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
143970
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425746724
—
MO
01
—
500018369
MEDICARE RAILROAD
MO
Enumeration date
12/07/2005
Last updated
12/02/2010
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