Provider Demographics
NPI:1356106587
Name:PETERSON, CINDY SUE (RN FIRST ASSIST,CNOR)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:SUE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN FIRST ASSIST,CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 ROUTE 50 STE 501
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3315
Mailing Address - Country:US
Mailing Address - Phone:703-259-7027
Mailing Address - Fax:703-591-0005
Practice Address - Street 1:12011 ROUTE 50 STE 501
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3315
Practice Address - Country:US
Practice Address - Phone:703-259-7027
Practice Address - Fax:703-591-0005
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001097760163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant