Provider Demographics
NPI:1508644881
Name:PETERSON, CALI (LPN)
Entity Type:Individual
Prefix:
First Name:CALI
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3016
Mailing Address - Country:US
Mailing Address - Phone:302-217-8168
Mailing Address - Fax:
Practice Address - Street 1:314 GROVE NECK RD
Practice Address - Street 2:
Practice Address - City:EARLEVILLE
Practice Address - State:MD
Practice Address - Zip Code:21919-3008
Practice Address - Country:US
Practice Address - Phone:410-275-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program