Provider Demographics
NPI:1063803922
Name:PEETERS, CLAIREN (RD)
Entity type:Individual
Prefix:
First Name:CLAIREN
Middle Name:
Last Name:PEETERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8964 AUGUSTINE CT
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4158
Mailing Address - Country:US
Mailing Address - Phone:916-517-7174
Mailing Address - Fax:
Practice Address - Street 1:8964 AUGUSTINE CT
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4158
Practice Address - Country:US
Practice Address - Phone:916-517-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILR13539133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered