Lise Anne Peterson

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Practice address

815 W Lancaster Blvd Ste 15
Lancaster, CA 93534-2303

Phone

(661) 916-8950

NPI assigned

Sep 18, 2008

Last updated

Nov 24, 2021By the provider in NPPES

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)

Not enrolled

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

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1487803110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42343 47TH ST WEST",
            "city": "QUARTZ HILL",
            "state": "CA",
            "postal_code": "93536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 W LANCASTER BLVD STE 15",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342303",
            "telephone_number": "661-916-8950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44817 Fern Ave",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "CA",
            "postal_code": "935343112",
            "country_code": "US",
            "telephone_number": "661-916-8950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LISE",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-18",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Nels Petersen, OD
• Courtney Peterson
• Destiny Peterson, BSN RN
• Jammie Peterson
• Jeanice Peterson, LEP
• Paul Anthony Peterson
• Alexander Petricevic
• Pavel Vaclav Petrik, MD
• Peyman Kafri Dental Corporation
• Mark Cameron Pfost

• Rehabilitation Practitioner in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Rehabilitation Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; 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.