Nanette Petersen, IBCLC

Primary specialty

Lactation Consultant (Non-RN)Taxonomy code 174N00000X

License

L23003 Issued in NC

Practice address

716 Phillips LN
Statesville, NC 28625-4594

Phone

(704) 677-8004

NPI assigned

Jul 16, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Nanette Davis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1657929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657929600000",
    "number": "1477288207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 PHILLIPS LN",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254594",
            "telephone_number": "704-677-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 PHILLIPS LN",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254594",
            "telephone_number": "704-677-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "NANETTE",
        "credential": "IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-16",
        "last_updated": "2022-07-16",
        "certification_date": "2022-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "NC",
            "license": "L23003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANETTE",
            "last_name": "DAVIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Personal Touch Care Team, Inc
• Personal Touch Care Team, Inc
• Personal Touch Care Team, Inc
• Frederick James Peters Jr.
• Lyn-Isha L Petersen
• Julie Beth Peterson, NP
• Joseph A Petrozza, MD
• Kurt Petterson, DPM
• Phasebdevelopment
• Mark R. Phebus, O.D.

• Lactation Consultant (Non-RN) in Statesville, NC
• Providers in Statesville, NC by specialty
• Lactation Consultant (Non-RN) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2022; 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.