Individual
BRIAN DOUGLAS PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6001 DODGE ST, OMAHA, NE 68182-1102
(402) 554-2800
Mailing address
2215 THOMAS DR, WATERLOO, NE 68069-4217
(402) 957-4276
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
12/13/2019
Last updated
12/13/2019
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