Active NPI
Elisabeth Olsen Peterson, PNP
- Pediatric Nurse Practitioner
- Duluth, GA
National Provider Identifier
1104211457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- RN234033
- Practice address
- 2660 Satellite Blvd
Duluth, GA 30096-5803 - Phone
- (404) 785-8330
- NPI assigned
- Apr 3, 2015
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | RN234033 | GA | Primary |
Addresses
Primary practice location
2660 Satellite Blvd
Duluth, GA 30096-5803
Mailing address
2660 Satellite Blvd
Duluth, GA 30096-5803
Phone (404) 785-8330
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: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN234033 | GA | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428019200000",
"number": "1104211457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2660 SATELLITE BLVD",
"city": "DULUTH",
"state": "GA",
"postal_code": "300965803",
"telephone_number": "404-785-8330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2660 SATELLITE BLVD",
"city": "DULUTH",
"state": "GA",
"postal_code": "300965803",
"telephone_number": "404-785-8330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "ELISABETH",
"middle_name": "OLSEN",
"credential": "PNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-03",
"last_updated": "2015-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "GA",
"license": "RN234033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; 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.