Nicole Maree Petersen, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP61094911 Issued in WA

Practice address

3950 Keene Rd
West Richland, WA 99353-4901

Phone

(509) 942-3130

Fax

(509) 628-8335

NPI assigned

Sep 22, 2020

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)

Enrolled

State licenses

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

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1730795030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 GAGE BLVD STE 101",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993529532",
            "telephone_number": "509-942-3627",
            "fax_number": "509-627-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 KEENE RD",
            "city": "WEST RICHLAND",
            "state": "WA",
            "postal_code": "993534901",
            "telephone_number": "509-942-3130",
            "fax_number": "509-628-8335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "NICOLE",
        "middle_name": "MAREE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-22",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61094911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paradise Family Dental
• Parkside Adult Family Home LLC
• Penttila Schroeder Maxfield,DDS, PS
• Wayne Fletcher Penttila, DDS
• Robert Harvey Perkes, DC
• Devin Marie Ramsay
• Emily A Reppe
• Lana K Reyes, LMT
• Christine Louise Richards, LMP
• Kayley Marie Risenhuber, MC70090165

• Family Nurse Practitioner in West Richland, WA
• Providers in West Richland, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; 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.