Active NPI
Carrie Dawn Peterson
- Student in an Organized Health Care Education/Training Program
- Santa Rosa, CA
National Provider Identifier
1457790842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- ASW33005
- Practice address
- 3333 Chanate Rd
Santa Rosa, CA 95404-1707 - Phone
- (707) 565-4700
- NPI assigned
- Jun 18, 2013
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | ASW33005 | CA | Primary |
Addresses
Primary practice location
3333 Chanate Rd
Santa Rosa, CA 95404-1707
Mailing address
PO Box 1735
Healdsburg, CA 95448-1735
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 |
|---|---|---|---|
| ASW33005 | CA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408320000000",
"number": "1457790842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1735",
"city": "HEALDSBURG",
"state": "CA",
"postal_code": "954481735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 CHANATE RD",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954041707",
"telephone_number": "707-565-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "CARRIE",
"middle_name": "DAWN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-18",
"last_updated": "2014-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": "ASW33005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.