Individual
JODI M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-0970
(602) 933-0068
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP3321
AZ
363LP2300X
Primary Care Nurse Practitioner
AP3321
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
423317
—
AZ
Enumeration date
03/06/2009
Last updated
03/26/2018
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