Provider Demographics
NPI:1467590398
Name:PETERSEN, KAIA (ARNP)
Entity Type:Individual
Prefix:
First Name:KAIA
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 SUNRISE CIR
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3628
Mailing Address - Country:US
Mailing Address - Phone:563-263-1326
Mailing Address - Fax:
Practice Address - Street 1:1609 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3426
Practice Address - Country:US
Practice Address - Phone:563-263-0122
Practice Address - Fax:563-263-0520
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-067497363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA22599OtherBLUE CROSS BLUE SHEILD
IAI0931Medicare ID - Type Unspecified
IA22599OtherBLUE CROSS BLUE SHEILD