Individual
MR. JAY WADEMAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
201 CEDAR ST SE, STE 800, ALBUQUERQUE, NM 87106-4917
(505) 563-2800
(505) 563-2821
Mailing address
201 CEDAR ST SE, STE 800, ALBUQUERQUE, NM 87106-4917
(505) 563-2800
(505) 563-2821
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R48991
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47737352
—
NM
Enumeration date
07/27/2006
Last updated
10/23/2008
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