Provider Demographics
NPI:1073834446
Name:PETERSON, AMY (CD(DONA))
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PENDEXTER RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-2108
Mailing Address - Country:US
Mailing Address - Phone:603-868-7804
Mailing Address - Fax:
Practice Address - Street 1:5 PENDEXTER RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2108
Practice Address - Country:US
Practice Address - Phone:603-868-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-19
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula