Provider Demographics
NPI:1831816909
Name:PETERSEN, ABBY (RN)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MOVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51039-7516
Mailing Address - Country:US
Mailing Address - Phone:712-870-1745
Mailing Address - Fax:
Practice Address - Street 1:180 10TH ST SE STE 201
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-2557
Practice Address - Country:US
Practice Address - Phone:712-546-4624
Practice Address - Fax:712-546-9395
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA169768163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse