Provider Demographics
NPI:1235847732
Name:PETERSON, ALEXANDRIA PISANO (DNP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:PISANO
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 E SOUTH BOULDER RD STE C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2304
Mailing Address - Country:US
Mailing Address - Phone:720-961-9970
Mailing Address - Fax:
Practice Address - Street 1:1335 E SOUTH BOULDER RD STE C
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2304
Practice Address - Country:US
Practice Address - Phone:720-961-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0998208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily