Adam Harrison Petrovich

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AG11230017 Issued in CO

Practice address

3576 Cascade CT
Broomfield, CO 80020-6501

Phone

(630) 885-0906

NPI assigned

Feb 19, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708300800000",
    "number": "1447015326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3576 CASCADE CT",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800206501",
            "telephone_number": "630-885-0906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3576 CASCADE CT",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800206501",
            "telephone_number": "630-885-0906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROVICH",
        "first_name": "ADAM",
        "middle_name": "HARRISON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "AG11230017",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CO",
            "license": "AG11230017",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "AG11230017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek Gene Petersen, D.D.S.
• Catherine Elizabeth Peterson, PA
• Eric Peterson, PHARMD
• Jenna Peterson, MA, LPCC
• Rebecca Renee Peterson, CBE, CPD, CNA
• Kyla Pettie
• Alicia Marie Pfeiffer, DPT
• Allison Roese Pfeiffer
• Katalin Pfeiffer, MNT
• Haley Pflum, RBT

• Nurse Practitioner in Broomfield, CO
• Providers in Broomfield, CO by specialty
• Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; 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.