Doctor Name: | KENT PETERSEN |
NPI Number: | 1053559401 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RN |
License Number: | 041300994 |
Business Practice Address: | 1604 Visa Dr Ste 1 Normal, IL - 617612195 |
Business Phone Number: | 3098464716 |
Business Fax Number: | 4094541107 |
Mailing Address: | 1604 Visa Dr Ste 1, NORMAL |
State: | IL |
Postal Code: | 617612195 |
Phone Number: | 3098464716 |
Fax Number: | 4094541107 |
NPI Enumeration Date: | 01/22/2009 |
NPI Last Update Date: | 01/22/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163W00000X |
License Number: | 041300994 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N. |