| Doctor Name: | WANDA MARIE PETERSON |
| NPI Number: | 1518084060 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | RN077378 |
| Business Practice Address: | 700 City Hall Dr Ft Oglethorpe, GA - 307427802 |
| Business Phone Number: | 7068613387 |
| Business Fax Number: | 7066385541 |
| Mailing Address: | 78 S Elmwood St, ROSSVILLE |
| State: | GA |
| Postal Code: | 307416613 |
| Phone Number: | 7068613387 |
| Fax Number: | 7066385541 |
| NPI Enumeration Date: | 03/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | RN077378 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |