Provider Demographics
NPI:1740310903
Name:PETERMAN, JASON R (RN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:PETERMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W MAIN ST
Mailing Address - Street 2:P.O. BOX 1445
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-4817
Mailing Address - Country:US
Mailing Address - Phone:360-748-6696
Mailing Address - Fax:360-748-0627
Practice Address - Street 1:135 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-4817
Practice Address - Country:US
Practice Address - Phone:360-748-6696
Practice Address - Fax:360-748-0627
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60065920163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health