Provider Demographics
NPI:1275764359
Name:PETERS, CLARA M
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65110
Mailing Address - Street 2:
Mailing Address - City:NULATO
Mailing Address - State:AK
Mailing Address - Zip Code:99765-0110
Mailing Address - Country:US
Mailing Address - Phone:907-898-2335
Mailing Address - Fax:
Practice Address - Street 1:400 SIS STREET
Practice Address - Street 2:
Practice Address - City:NULATO
Practice Address - State:AK
Practice Address - Zip Code:99765-0110
Practice Address - Country:US
Practice Address - Phone:907-898-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program