Provider Demographics
NPI:1790149623
Name:PETERS, AGNES (RN)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:PETERS
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 1:10 CRYSTAL COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-2274
Mailing Address - Country:US
Mailing Address - Phone:607-739-4277
Mailing Address - Fax:
Practice Address - Street 1:10 CRYSTAL COMMONS DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-2274
Practice Address - Country:US
Practice Address - Phone:607-739-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433721163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse