Pamela H Petersen, CNM

Primary specialty

MidwifeTaxonomy code 176B00000X

License

F000419 Issued in NY

Practice address

10 Benton Avenue
Middletown, NY 10940

Phone

(845) 343-7614

Fax

(845) 343-5390

NPI assigned

Dec 28, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1548326317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 ROUTE 9W STE 10",
            "city": "CORNWALL",
            "state": "NY",
            "postal_code": "125181370",
            "telephone_number": "845-220-3100",
            "fax_number": "845-534-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 BENTON AVENUE",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "10940",
            "telephone_number": "845-343-7614",
            "fax_number": "845-343-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "PAMELA",
        "middle_name": "H",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "NY",
            "license": "F000419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00355931",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Peterman
• Susan Peters Manez, MSRD
• Marian Peters
• Scott C Peters, D.M.D.
• Jennifer L Petersen, CCC-SLP
• Amanda Joy Peterson
• Travonna Peterson, FNP-BC
• Katherine A. Petrillo, R.N.
• Christine Pettit, APRN
• Grace Pettus

• Midwife in Middletown, NY
• Providers in Middletown, NY by specialty
• Midwife in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.