Provider Demographics
NPI:1669925251
Name:PETERS, NICOLETTE (CRNP)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NICOLETTE
Other - Middle Name:
Other - Last Name:BOHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1722 PINE ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1103
Mailing Address - Country:US
Mailing Address - Phone:334-240-2337
Mailing Address - Fax:334-293-6859
Practice Address - Street 1:2000 PEPPERELL PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5452
Practice Address - Country:US
Practice Address - Phone:334-528-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-142693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner