| NPI | 1699024497 |
|---|---|
| Former Name | TIFFANY K PETERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA A112954) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A112954) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2022-01-03 |