Provider Demographics
NPI:1437508181
Name:PETERSON, ANN-MARIE (RN)
Entity Type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 INDEPENDENCE WAY STE B
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9417
Mailing Address - Country:US
Mailing Address - Phone:719-587-5191
Mailing Address - Fax:719-589-1103
Practice Address - Street 1:8900 INDEPENDENCE WAY STE B
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-9417
Practice Address - Country:US
Practice Address - Phone:719-587-5191
Practice Address - Fax:719-589-1103
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN199195163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health