| NPI | 1316152127 |
|---|---|
| Former Name | STACEY L. PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0214X Pediatrics Pediatric Pulmonology (Licence: IN 01073456) |
| Additional Taxonomies | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: IN 01073456) |
| 207LC0200X Anesthesiology Critical Care Medicine (Licence: IN 01073456) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2014-05-06 |