Provider Demographics
NPI:1275836470
Name:PETERSON, RISA LYNN (CD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:RISA
Middle Name:LYNN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8553 AMES AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3134
Mailing Address - Country:US
Mailing Address - Phone:402-505-2613
Mailing Address - Fax:
Practice Address - Street 1:8553 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-3134
Practice Address - Country:US
Practice Address - Phone:402-505-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula