Provider Demographics
NPI:1285430686
Name:PETERSEN, COURTNEY N
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:N
Last Name:PETERSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 CRYSTAL ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NE
Mailing Address - Zip Code:68038-2521
Mailing Address - Country:US
Mailing Address - Phone:402-870-7646
Mailing Address - Fax:
Practice Address - Street 1:1600 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-6877
Practice Address - Country:US
Practice Address - Phone:402-494-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care