Debra Antoinette Petersen, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

28063616A Issued in IN

Practice address

7131 Indianapolis Blvd
Hammond, IN 46324

Phone

(219) 845-0848

NPI assigned

Oct 19, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417039652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8918 BLAINE PL",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463078102",
            "telephone_number": "219-365-2368",
            "fax_number": "219-365-2408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7131 INDIANAPOLIS BLVD",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "46324",
            "telephone_number": "219-845-0848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "DEBRA",
        "middle_name": "ANTOINETTE",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28063616A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Path to Purpose Living LLC
• Patrick Pontee M.D.
• Svetlana Pekovic, O.D.
• John F Perez, MD
• Jovan Perkins, RPH, PHARMD
• Taryn Petty, NP-C
• Pharma-Card West, Inc
• Shekila Nicole Phillips
• Joseph Piekarczyk Jr., DDS
• Melissa Carol Pietraszak

• Family Nurse Practitioner in Hammond, IN
• Providers in Hammond, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.