Doctor Name: | MS. KELLI V PETERS |
NPI Number: | 1336138627 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | MP000023 |
Business Practice Address: | 318 White Horse Pike Haddon Heights, NJ - 080351705 |
Business Phone Number: | 8565476000 |
Business Fax Number: | 8565463189 |
Mailing Address: | 402 Lippincott Dr, MARLTON |
State: | NJ |
Postal Code: | 080534112 |
Phone Number: | 8567823300 |
Fax Number: | 8565048029 |
NPI Enumeration Date: | 10/19/2005 |
NPI Last Update Date: | 04/09/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MP000023 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |