Petaloso Inc

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

420 Issued in AK

Legal business name

PETALOSO INC

Doing business as

Petaloso

Practice address

1867 Airport Way Ste 110B
Fairbanks, AK 99701-4054

Phone

(907) 978-7721

Fax

(907) 452-6330

NPI assigned

Apr 27, 2016

Last updated

Apr 27, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janice L Stables, MSN, ANP

Title

President

Phone

(907) 978-7721

Specialties & licenses 1

Addresses

Other names 1

• Petaloso Doing business as

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461715200000",
    "number": "1982059952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1867 AIRPORT WAY STE 110B",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014054",
            "telephone_number": "907-978-7721",
            "fax_number": "907-452-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1867 AIRPORT WAY STE 110B",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014054",
            "telephone_number": "907-978-7721",
            "fax_number": "907-452-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETALOSO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-04-27",
        "status": "A",
        "authorized_official_last_name": "STABLES",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-978-7721",
        "authorized_official_credential": "MSN, ANP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petaloso",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chad D Personett, OD
• Colleen Personett, OD
• Karissa Persson, RN
• Tammi Persson
• Michelle Peschke
• Pete B Higgins DDS LLC (Four Corners Dental Group)
• Bernard Joseph Pete
• Donald Brent Petersen
• David James Peterson, O.D.
• Ella Peterson

• Family Nurse Practitioner in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Family Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.

Verify at the official NPI Registry.