Individual
JUSTIN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
323 N 7TH AVE, BROKEN BOW, NE 68822-1718
(308) 872-6821
(308) 872-2751
Mailing address
323 N 7TH AVE, BROKEN BOW, NE 68822-1718
(308) 872-6821
(308) 872-2751
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/18/2022
Last updated
01/18/2022
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