| Doctor Name: | JAMIE PETERSON |
| NPI Number: | 1366811739 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 820652 |
| Business Practice Address: | 286 S 16th St Grover Beach, CA - 934332245 |
| Business Phone Number: | 8054737050 |
| Business Fax Number: | 8054747473 |
| Mailing Address: | 286 S 16th St, GROVER BEACH |
| State: | CA |
| Postal Code: | 934332245 |
| Phone Number: | 8054737050 |
| Fax Number: | 8054747473 |
| NPI Enumeration Date: | 09/16/2015 |
| NPI Last Update Date: | 09/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0400X |
| License Number: | 820652 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Case Management |
| Taxonomy Definition: | |