Active NPI
Michael Latrae Peterson
- Social Worker
- Las Vegas, NV
National Provider Identifier
1548715634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 1703509043
- Practice address
- 6767 W Windmill LN
Las Vegas, NV 89139-6501 - Phone
- (702) 578-0608
- NPI assigned
- Aug 18, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 1703509043 | NV | Primary |
Addresses
Primary practice location
6767 W Windmill LN
Las Vegas, NV 89139-6501
Mailing address
6767 W Windmill LN
Las Vegas, NV 89139-6501
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 |
|---|---|---|---|
| 1703509043 | NV | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471478400000",
"number": "1548715634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6767 W WINDMILL LN",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891396501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6767 W WINDMILL LN",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891396501",
"telephone_number": "702-578-0608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MICHAEL",
"middle_name": "LATRAE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-18",
"last_updated": "2016-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NV",
"license": "1703509043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.