Provider Demographics
NPI:1902405665
Name:PETERSEN, ALICE (MSN, FNP-C, CCRA)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MSN, FNP-C, CCRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-0187
Mailing Address - Country:US
Mailing Address - Phone:910-267-0421
Mailing Address - Fax:855-996-9090
Practice Address - Street 1:444 SW CENTER ST
Practice Address - Street 2:
Practice Address - City:FAISON
Practice Address - State:NC
Practice Address - Zip Code:28341-8820
Practice Address - Country:US
Practice Address - Phone:910-267-0421
Practice Address - Fax:910-267-8989
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily