| Doctor Name: | DIANE KATHRYN PETERSON |
| NPI Number: | 1144471210 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 9908 |
| Business Practice Address: | 23970 Jacaranda Dr Tehachapi, CA - 935618320 |
| Business Phone Number: | 6618213821 |
| Business Fax Number: | 6618211217 |
| Mailing Address: | 23970 Jacaranda Dr, TEHACHAPI |
| State: | CA |
| Postal Code: | 935618320 |
| Phone Number: | 6618213821 |
| Fax Number: | 6618211217 |
| NPI Enumeration Date: | 10/07/2008 |
| NPI Last Update Date: | 10/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | 9908 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |