Provider Demographics
NPI:1124132808
Name:PETERSEN-SMITH, ANN (PNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:PETERSEN-SMITH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:13123 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:303-777-6888
Mailing Address - Fax:720-777-2570
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6888
Practice Address - Fax:720-777-2570
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO74638363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics