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1275106254
TED STEVEN PETERSON
ROCKFORD, IL
NPI
1275106254
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: IL 209023474)
Enumeration Date
2021-07-19
Last Update Date
2023-09-08
Business Address
TED STEVEN PETERSON APN
5875 EAST RIVERSIDE BLVD
ROCKFORD, IL 61114
Phone number: 815-398-9491
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Mailing Address
TED STEVEN PETERSON APN
PO BOX 735263
CHICAGO, IL 60673-5263
Phone number:
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