Active NPI
Georgette Peterson
- Licensed Practical Nurse
- Paw Paw, MI
National Provider Identifier
1053738781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 4704138858
- Practice address
- 801 Hazen St
Paw Paw, MI 49079-2008 - Phone
- (269) 655-3334
- Fax
- (269) 657-6523
- NPI assigned
- Mar 19, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 4704138858 | MI | Primary |
Addresses
Primary practice location
801 Hazen St
Paw Paw, MI 49079-2008
Mailing address
801 Hazen St
Paw Paw, MI 49079-2008
Phone (269) 655-3334
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704138858 | MI | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395187200000",
"number": "1053738781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 HAZEN ST",
"city": "PAW PAW",
"state": "MI",
"postal_code": "490792008",
"telephone_number": "269-655-3334",
"fax_number": "269-657-6523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 HAZEN ST",
"city": "PAW PAW",
"state": "MI",
"postal_code": "490792008",
"telephone_number": "269-655-3334",
"fax_number": "269-657-6523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "GEORGETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-19",
"last_updated": "2014-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MI",
"license": "4704138858",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paw Paw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.