Provider Demographics
NPI:1336131523
Name:PETERSEN, CHRISTI L (FNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTI
Middle Name:L
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18127 APPLE COLONY RD
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-9626
Mailing Address - Country:US
Mailing Address - Phone:209-928-3010
Mailing Address - Fax:
Practice Address - Street 1:900 GREENLEY RD
Practice Address - Street 2:STE 922
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5287
Practice Address - Country:US
Practice Address - Phone:209-536-3738
Practice Address - Fax:209-533-9608
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN265299163W00000X
CANP7349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P37411Medicare UPIN
CAZZZ212982Medicare ID - Type Unspecified