Active NPI
Jill Peterson
- Specialist
- Coeur D Alene, ID
National Provider Identifier
1700107612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 60093876
- Practice address
- 6125 N Sunshine St
Coeur D Alene, ID 83815 - Phone
- (208) 964-4457
- NPI assigned
- Jun 15, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | MA 60093876 | WA | Primary |
Addresses
Primary practice location
6125 N Sunshine St
Coeur D Alene, ID 83815
Mailing address
213 E Miles Ave
Hayden, ID 83835-8204
Phone (208) 964-4457
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 |
|---|---|---|---|
| MA 60093876 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276560000000",
"number": "1700107612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "213 E MILES AVE",
"city": "HAYDEN",
"state": "ID",
"postal_code": "838358204",
"telephone_number": "208-964-4457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6125 N SUNSHINE ST",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "83815",
"telephone_number": "208-964-4457"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JILL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-15",
"last_updated": "2010-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA 60093876",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.