Provider Demographics
NPI:1265868715
Name:PETERSON, LAURA S (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:PETERSON
Suffix:
Gender:F
Credentials:FNP
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Other - Credentials:
Mailing Address - Street 1:15995 TUSCOLA RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2159
Mailing Address - Country:US
Mailing Address - Phone:760-946-1592
Mailing Address - Fax:760-946-1949
Practice Address - Street 1:15995 TUSCOLA RD
Practice Address - Street 2:SUITE 208
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2159
Practice Address - Country:US
Practice Address - Phone:760-946-1592
Practice Address - Fax:760-946-1949
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2023-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP 22436363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily