Petersen, Michelle E

Petersen, Michelle E is an individual health care provider with primary practice located at 1608 E Evergreen St Suite A, Cameron MO 64429-2400. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Petersen, Michelle E can be contacted via phone (816) 632-5424.

Contact Information

Primary practice address
1608 E Evergreen St Suite A Cameron MO 64429-2400
Fax: (816) 632-7094
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 143970 Missouri

Profile Details

NPI number 1811972458
LBN Legal business name Petersen, Michelle E
Credentials RN, CS, FNP
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 7th, 2005
Last updated Dec 2nd, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811972458 NPPES
Missouri MEDICAID 425746724
Missouri Other 500018369

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