Individual
NICOLE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 E 89TH AVE STE 2A, MERRILLVILLE, IN 46410-7319
(219) 736-2800
(219) 736-6680
Mailing address
200 E 89TH AVE STE 2A, MERRILLVILLE, IN 46410-7319
(219) 736-2800
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10003571A
IN
Other
Enumeration date
08/23/2022
Last updated
08/23/2022
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