Provider Demographics
NPI:1881722866
Name:PETERSEN, NANCY M (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 WEST RD
Mailing Address - Street 2:
Mailing Address - City:STEPHENTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12168-3613
Mailing Address - Country:US
Mailing Address - Phone:413-499-8568
Mailing Address - Fax:
Practice Address - Street 1:100 WENDELL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7065
Practice Address - Country:US
Practice Address - Phone:413-443-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195833363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology