Active NPI
Brett Ian Peterson
- Registered Dietitian
- Ishpeming, MI
National Provider Identifier
1134610371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 915544
- Practice address
- 901 Lakeshore Dr
Ishpeming, MI 49849-1367 - Phone
- (906) 485-2623
- NPI assigned
- May 23, 2018
- Last updated
- May 23, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 915544 | MI | Primary |
Addresses
Primary practice location
901 Lakeshore Dr
Ishpeming, MI 49849-1367
Mailing address
550 W Hewitt Ave
Marquette, MI 49855-3323
Phone (906) 236-5325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 915544 | MI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527033600000",
"number": "1134610371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 W HEWITT AVE",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498553323",
"telephone_number": "906-236-5325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 LAKESHORE DR",
"city": "ISHPEMING",
"state": "MI",
"postal_code": "498491367",
"telephone_number": "906-485-2623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "BRETT",
"middle_name": "IAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-23",
"last_updated": "2018-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MI",
"license": "915544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ishpeming, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.