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1467195552
TRAVIS DALE PETERSON
PROVO, UT
NPI
1467195552
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LN0000X Nurse Practitioner, Neonatal
(Licence: UT 8058003-4405)
Enumeration Date
2022-04-15
Last Update Date
2023-01-09
Business Address
TRAVIS DALE PETERSON RN
1034 N 500 W
PROVO, UT 84604-3380
Phone number: 801-357-7414
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Mailing Address
TRAVIS DALE PETERSON RN
PO BOX 27128
SALT LAKE CITY, UT 84127-0128
Phone number:
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