Provider Demographics
NPI:1740342997
Name:PETERS, DONNA L (CNP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:PETERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2202
Mailing Address - Country:US
Mailing Address - Phone:605-642-6337
Mailing Address - Fax:605-642-6339
Practice Address - Street 1:930 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2202
Practice Address - Country:US
Practice Address - Phone:605-642-6337
Practice Address - Fax:605-642-6339
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000119363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health