Provider Demographics
NPI:1144379116
Name:PETERSON, CHRISTINE JANE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JANE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 W 119TH MEWS
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-5027
Mailing Address - Country:US
Mailing Address - Phone:720-315-5612
Mailing Address - Fax:
Practice Address - Street 1:6455 S YOSEMITE ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5139
Practice Address - Country:US
Practice Address - Phone:303-718-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004628363LF0000X
CO99490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily