Provider Demographics
NPI:1427003136
Name:PETERSON, KRISTI K (MD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:K
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 S 72ND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3423
Mailing Address - Country:US
Mailing Address - Phone:402-827-9400
Mailing Address - Fax:402-827-9405
Practice Address - Street 1:10701 S 72ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3423
Practice Address - Country:US
Practice Address - Phone:402-827-9400
Practice Address - Fax:402-827-9405
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17847207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEE94036Medicare UPIN
NE264271Medicare ID - Type Unspecified