Provider Demographics
NPI:1770627861
Name:KRISTI K PETERSON MD PC
Entity Type:Organization
Organization Name:KRISTI K PETERSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:K
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-827-9400
Mailing Address - Street 1:10701 S 72ND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3427
Mailing Address - Country:US
Mailing Address - Phone:402-827-9400
Mailing Address - Fax:402-827-9405
Practice Address - Street 1:10701 S 72ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3427
Practice Address - Country:US
Practice Address - Phone:402-827-9400
Practice Address - Fax:402-827-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty