Organization
PETERSON WELLNESS PRIMARY CARE AND PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHTON DANIELLE PETERSON NP (NURSE PRACTITIONER, OWNER)
(918) 724-3952
Entity
Organization
Contact information
Practice address
109 W COMMERCIAL ST, BROKEN ARROW, OK 74012-4012
(918) 724-3952
Mailing address
9701 SPRING LAKE DR, BROKEN ARROW, OK 74014-3426
(918) 724-3952
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200833910A
—
OK
Enumeration date
09/22/2021
Last updated
09/22/2021
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