Individual
MARA BERENICE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1620 W HARRISON ST, CHICAGO, IL 60612-3801
(414) 430-4779
Mailing address
200 N JEFFERSON ST APT 1610, CHICAGO, IL 60661-1280
(414) 430-4779
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
250580-30
WI
Other
Enumeration date
07/08/2025
Last updated
07/08/2025
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