Individual
HEIDI JANE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2516 N OZARK AVE, JOPLIN, MO 64801-4716
(417) 782-8417
Mailing address
2516 N OZARK AVE, JOPLIN, MO 64801-4716
(417) 782-8417
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
100802
MO
367500000X
Certified Registered Nurse Anesthetist
54629
KS
367500000X
Certified Registered Nurse Anesthetist
C01138
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
R0053014
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100786900A
—
OK
05
—
152776701
—
AR
05
—
200468380N
—
OK
05
—
500156005
—
MO
05
—
919696534
—
MO
05
—
919696567
—
MO
Enumeration date
08/10/2006
Last updated
04/16/2014
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