Provider Demographics
NPI:1467757187
Name:PETERS, WILMA DEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:DEAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:WILMA
Other - Middle Name:DEAN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:102 WHITES GAP ROAD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411
Mailing Address - Country:US
Mailing Address - Phone:240-405-6632
Mailing Address - Fax:304-258-7992
Practice Address - Street 1:102 WHITES GAP ROAD
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411
Practice Address - Country:US
Practice Address - Phone:240-405-6632
Practice Address - Fax:304-258-7992
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR101792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse