| NPI | 1245994839 | 
|---|---|
| Former Name | MERIDITH PETERSON | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 25657) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC AG10210066) | 
| Enumeration Date | 2021-10-28 | 
| Last Update Date | 2025-07-28 |