Provider Demographics
NPI:1497733711
Name:PETERS, LILLIAN FERN (RN ARNO BC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:FERN
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN ARNO BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0467
Mailing Address - Country:US
Mailing Address - Phone:316-284-6400
Mailing Address - Fax:316-284-6491
Practice Address - Street 1:1901 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-0467
Practice Address - Country:US
Practice Address - Phone:316-284-6400
Practice Address - Fax:316-284-6491
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74328163W00000X
KS1324579092364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMP0533073OtherDEA LICENSE #
DCMP0533073OtherDEA LICENSE #
044964Medicare ID - Type Unspecified