Provider Demographics
NPI:1114783693
Name:PETERSON, JENNIFER DELIA (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DELIA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3202
Mailing Address - Country:US
Mailing Address - Phone:714-478-0361
Mailing Address - Fax:
Practice Address - Street 1:950 E FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3202
Practice Address - Country:US
Practice Address - Phone:714-478-0361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95100231163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant