Individual
KEELY AUBREY PETERSEN-SNIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
3156 STATE ST, MEDFORD, OR 97504
(541) 476-2373
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
073586
IA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201050176NP
OR
Other
Enumeration date
09/18/2007
Last updated
10/22/2018
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