Individual
RIO PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
4020 GRANITE VIEW ROAD, NEW MEADOWS, ID 83654
(209) 677-7747
(888) 849-5240
Mailing address
260 BONNER MALL WAY # 1028, PONDERAY, ID 83852-9748
(209) 677-7747
(888) 849-5240
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
70072
ID
Other
Enumeration date
08/19/2021
Last updated
02/28/2024
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