Provider Demographics
NPI:1689917114
Name:PETERSON, ALMA J (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALMA
Middle Name:J
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 1ST ST
Mailing Address - Street 2:
Mailing Address - City:RUSSIA
Mailing Address - State:OH
Mailing Address - Zip Code:45363-9742
Mailing Address - Country:US
Mailing Address - Phone:937-684-5143
Mailing Address - Fax:
Practice Address - Street 1:411 BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:RUSSIA
Practice Address - State:OH
Practice Address - Zip Code:45363-9758
Practice Address - Country:US
Practice Address - Phone:937-526-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH273217163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse