Provider Demographics
NPI:1700181922
Name:PETERSON, KARL ROBERT (APRN CNM)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:ROBERT
Last Name:PETERSON
Suffix:
Gender:M
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 GOLDEN CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1658
Mailing Address - Country:US
Mailing Address - Phone:636-273-1298
Mailing Address - Fax:
Practice Address - Street 1:317 GOLDEN CHERRY DR
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:MO
Practice Address - Zip Code:63040-1658
Practice Address - Country:US
Practice Address - Phone:636-273-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003021203176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife