Provider Demographics
NPI:1093598567
Name:PETERSON, COLLIN (RN)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE, 525 VINE ST
Mailing Address - Street 2:NURSE ANESTHESIA PROGRAM, SUITE 230
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101
Mailing Address - Country:US
Mailing Address - Phone:336-716-1411
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE, 525 VINE ST
Practice Address - Street 2:NURSE ANESTHESIA PROGRAM, SUITE 230
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101
Practice Address - Country:US
Practice Address - Phone:336-716-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program