Provider Demographics
NPI:1508142175
Name:PETERSON, CHRISTINE LOUISE (CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 TINY TOWN RD STE 252
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042
Mailing Address - Country:US
Mailing Address - Phone:210-896-2241
Mailing Address - Fax:
Practice Address - Street 1:1477 TINY TOWN RD STE 252
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4753
Practice Address - Country:US
Practice Address - Phone:210-896-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705385367A00000X
TN23155367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife