Provider Demographics
NPI:1043226046
Name:PETERSON, STEPHANIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5901 S 58TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3646
Mailing Address - Country:US
Mailing Address - Phone:402-261-3443
Mailing Address - Fax:888-324-5311
Practice Address - Street 1:5901 S 58TH ST STE B
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3646
Practice Address - Country:US
Practice Address - Phone:402-261-3443
Practice Address - Fax:888-324-5311
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE23461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEI46412Medicare UPIN