Provider Demographics
NPI:1518414911
Name:PETERS, CHARLI DANIELLE (APR N)
Entity Type:Individual
Prefix:MRS
First Name:CHARLI
Middle Name:DANIELLE
Last Name:PETERS
Suffix:
Gender:F
Credentials:APR N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9636 S SKYE PARK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1506
Mailing Address - Country:US
Mailing Address - Phone:435-650-6274
Mailing Address - Fax:
Practice Address - Street 1:9636 S SKYE PARK RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-1506
Practice Address - Country:US
Practice Address - Phone:435-650-6274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7003608-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care