Provider Demographics
NPI:1598205189
Name:PETERSON, CHRISTINE MARIA (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S TELSHOR BLVD
Mailing Address - Street 2:MEMORIAL MEDICAL CENTER
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5141
Mailing Address - Country:US
Mailing Address - Phone:575-521-5042
Mailing Address - Fax:575-521-5045
Practice Address - Street 1:2100 S TRIVIZ DR
Practice Address - Street 2:SUITE G
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-0605
Practice Address - Country:US
Practice Address - Phone:575-556-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM430133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered