Provider Demographics
NPI:1295132264
Name:PETERSEN, BRITTANY RAE (MA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:RAE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:RAE
Other - Last Name:BRAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:202 E EARLL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2647
Mailing Address - Country:US
Mailing Address - Phone:602-599-5404
Mailing Address - Fax:602-599-5704
Practice Address - Street 1:40 E MITCHELL DR
Practice Address - Street 2:SUITE 100 & 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2330
Practice Address - Country:US
Practice Address - Phone:602-599-5614
Practice Address - Fax:602-599-5814
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator