Provider Demographics
NPI:1295030690
Name:PETERSON, LOUISE MARIE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:MARIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 356079
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-3208
Mailing Address - Country:US
Mailing Address - Phone:206-598-4628
Mailing Address - Fax:
Practice Address - Street 1:2124 4TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2308
Practice Address - Country:US
Practice Address - Phone:206-263-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 00111274163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant