Provider Demographics
NPI:1558963611
Name:PETERSEN, KAREN ANN-MARIE ELIZABETH (MPH, RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN-MARIE ELIZABETH
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MPH, RDN, LD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH, RDN, LD
Mailing Address - Street 1:6900 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-4400
Mailing Address - Country:US
Mailing Address - Phone:702-885-7194
Mailing Address - Fax:
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-885-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered