Active NPI
Stacie Petersen, RN, CDE
- Case Management Registered Nurse
- West Point, NE
National Provider Identifier
1265835391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Registered Nurse
- License
- 49907
- Practice address
- 430 N Monitor St
West Point, NE 68788-1595 - Phone
- (402) 372-2404
- Fax
- (402) 372-2360
- NPI assigned
- Oct 3, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Registered Nurse | 163WC0400X | 49907 | NE | Primary |
| Diabetes Educator Registered Nurse | 163WD0400X | 49907 | NE |
Addresses
Primary practice location
430 N Monitor St
West Point, NE 68788-1595
Mailing address
430 N Monitor St
West Point, NE 68788-1595
Phone (402) 372-2404
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49907 | NE | MD | Case Management Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412294400000",
"number": "1265835391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 N MONITOR ST",
"city": "WEST POINT",
"state": "NE",
"postal_code": "687881595",
"telephone_number": "402-372-2404",
"fax_number": "402-372-2360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 N MONITOR ST",
"city": "WEST POINT",
"state": "NE",
"postal_code": "687881595",
"telephone_number": "402-372-2404",
"fax_number": "402-372-2360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "STACIE",
"name_prefix": "Ms.",
"credential": "RN, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-03",
"last_updated": "2014-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Case Management",
"state": "NE",
"license": "49907",
"primary": true
},
{
"code": "163WD0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Diabetes Educator",
"state": "NE",
"license": "49907",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Point, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.