Active NPI
Sheryl Peterson
- Registered Nurse
- Portland, OR
National Provider Identifier
1801285705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 094006767RN
- Practice address
- 17720 NE Halsey St
Portland, OR 97230-6734 - Phone
- (503) 654-7654
- Fax
- (503) 654-7333
- NPI assigned
- Jan 15, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 094006767RN | OR | Primary |
Addresses
Primary practice location
17720 NE Halsey St
Portland, OR 97230-6734
Mailing address
3587 Heathrow Way
Medford, OR 97504-4004
Phone (503) 545-9787
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 |
|---|---|---|---|
| 094006767RN | OR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456272000000",
"number": "1801285705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3587 HEATHROW WAY",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975044004",
"telephone_number": "503-545-9787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17720 NE HALSEY ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972306734",
"telephone_number": "503-654-7654",
"fax_number": "503-654-7333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "SHERYL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-15",
"last_updated": "2016-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OR",
"license": "094006767RN",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.