Individual
ANGELA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
37 S 2ND E, REXBURG, ID 83440-1906
(208) 356-0234
Mailing address
37 S 2ND E, REXBURG, ID 83440-1906
(208) 356-0234
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
65031
ID
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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