Provider Demographics
NPI:1235490962
Name:PETERS, ANITA R (PBMT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:PETERS
Suffix:
Gender:F
Credentials:PBMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31330 SCHOOLCRAFT RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2041
Mailing Address - Country:US
Mailing Address - Phone:734-525-9712
Mailing Address - Fax:
Practice Address - Street 1:31330 SCHOOLCRAFT RD
Practice Address - Street 2:STE 200
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2041
Practice Address - Country:US
Practice Address - Phone:734-525-9712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other