Provider Demographics
NPI:1750874459
Name:PETERSEN, VALERIE L (WHNP-BC)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:L
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:L
Other - Last Name:WEZRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3752 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-2028
Mailing Address - Country:US
Mailing Address - Phone:773-762-2435
Mailing Address - Fax:773-762-2017
Practice Address - Street 1:3752 W 16TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2028
Practice Address - Country:US
Practice Address - Phone:773-762-2435
Practice Address - Fax:773-762-2017
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017767363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty