Provider Demographics
NPI:1972660389
Name:PETERSON, BARBARA J (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:J
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-2140
Mailing Address - Country:US
Mailing Address - Phone:906-265-9913
Mailing Address - Fax:906-265-2950
Practice Address - Street 1:601 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-2140
Practice Address - Country:US
Practice Address - Phone:906-265-9913
Practice Address - Fax:906-265-2950
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704129953363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health