Provider Demographics
NPI:1184799850
Name:PETERSEN, LINDA A (ARNP, CFNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:ARNP, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:855 A AVE NE
Mailing Address - Street 2:P O BOX 3080
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-3080
Mailing Address - Country:US
Mailing Address - Phone:319-368-5500
Mailing Address - Fax:319-368-5503
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:J EDWARD LUNDY PAVILION 4TH FLOOR
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-221-8400
Practice Address - Fax:319-221-8403
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAA067778363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology