| Doctor Name: | PHYLLIS G PETERSON |
| NPI Number: | 1366703019 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 2065 |
| Business Practice Address: | 103 Dr. Bowen St. Belle Chasse, LA - 70037 |
| Business Phone Number: | 5043923392 |
| Business Fax Number: | 5043923303 |
| Mailing Address: | 103 Dr. Bowen St., BELLE CHASSE |
| State: | LA |
| Postal Code: | 70037 |
| Phone Number: | 5043923392 |
| Fax Number: | 5043923303 |
| NPI Enumeration Date: | 05/30/2012 |
| NPI Last Update Date: | 06/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 2065 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |