Individual
JEANNIE MARIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1102 W 32ND ST, JOPLIN, MO 64804-3503
(417) 347-1111
Mailing address
302 N HOSPITAL DR, GIRARD, KS 66743-2000
(417) 347-1078
(417) 347-1079
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
55028
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100389550D
—
KS
05
—
100787980A
—
OK
01
—
430061375
RR MEDICARE
—
05
—
915240105
—
MO
Enumeration date
01/25/2006
Last updated
04/24/2024
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