Provider Demographics
NPI:1528099983
Name:PETERSEN, MARTINA (NP)
Entity type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2346
Mailing Address - Country:US
Mailing Address - Phone:845-621-2677
Mailing Address - Fax:
Practice Address - Street 1:WHITE PLAINS HOSPITAL CENTER
Practice Address - Street 2:DAVIS AVE @ EAST POST ROAD
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-681-1158
Practice Address - Fax:914-681-2878
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430124363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care