Mary K Peterson, APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

000666 Issued in CT

Practice address

451 State St
North Haven, CT 06473-3070

Phone

(203) 248-8888

Fax

(860) 621-5169

NPI assigned

Feb 27, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DCABDA/Endpoint/DCABDA
• Direct secure messaging: mpeterson512450@direct.ynhh.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Complete Pediatrics

  • Pediatric Adolescent Medicine Physician
  • North Haven, CT
  • NPI 1871731927

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1063548428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 STATE ST",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064733070",
            "telephone_number": "203-248-8888",
            "fax_number": "860-621-5169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 STATE ST",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064733070",
            "telephone_number": "203-248-8888",
            "fax_number": "860-621-5169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "000666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF CT LICENSE #",
            "identifier": "000666",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• People'S Home Healthcare Inc.
• Peoples Home Healthcare Inc
• Joanna Lynn Perez, OT/L
• Ronald S. Perpetua, DNP
• John Jeffrey Peters, MD
• Fausto Petruzziello, MD
• Shana Nicole Pettway
• Caisea Phillips, PT, DPT
• Michelle Jean Piccerillo, LMFT
• Elise Rachel Picciuto

• Pediatric Nurse Practitioner in North Haven, CT
• Providers in North Haven, CT by specialty
• Pediatric Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.