Provider Demographics
NPI:1982021952
Name:PETERS, DORTHEA (FNP-C)
Entity Type:Individual
Prefix:
First Name:DORTHEA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAMMOTH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4145
Mailing Address - Country:US
Mailing Address - Phone:603-623-3995
Mailing Address - Fax:
Practice Address - Street 1:250 MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4145
Practice Address - Country:US
Practice Address - Phone:603-623-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH077383-23363LF0000X
FL9291236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily