Provider Demographics
NPI:1275668337
Name:PETERSEN, ANN MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:PETERSEN
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:USAMEDDAC WUERZBURG UNIT 26610
Mailing Address - Street 2:ATTN CREDENTIALS OFFICE
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09224
Mailing Address - Country:US
Mailing Address - Phone:0149-931-8043
Mailing Address - Fax:01149-931-8043
Practice Address - Street 1:USAMEDDAC WUERZBURG UNIT 26610
Practice Address - Street 2:US ARMY HEALTH CLINIC SCHWEINFURT
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09033
Practice Address - Country:US
Practice Address - Phone:011490972-196-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN304736163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse