Provider Demographics
NPI:1083969455
Name:PETERSON, STEFFANIE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:STEFFANIE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 S 3000 E
Mailing Address - Street 2:STE 220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6924
Mailing Address - Country:US
Mailing Address - Phone:801-944-3199
Mailing Address - Fax:801-944-3180
Practice Address - Street 1:368 E RIVERSIDE DR
Practice Address - Street 2:STE A
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6897
Practice Address - Country:US
Practice Address - Phone:435-673-1149
Practice Address - Fax:435-673-1182
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5322635-8900363LF0000X
UT5322635-4405364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily