Provider Demographics
NPI:1356159842
Name:PETERSON, CHET (RN, CCM, CDCES)
Entity type:Individual
Prefix:
First Name:CHET
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:RN, CCM, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2019
Mailing Address - Country:US
Mailing Address - Phone:970-824-8233
Mailing Address - Fax:970-870-1326
Practice Address - Street 1:745 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2019
Practice Address - Country:US
Practice Address - Phone:970-824-8233
Practice Address - Fax:970-870-1326
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4241846163WC0400X
CO32305508163WD0400X
CORN.1629651163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse