Provider Demographics
NPI:1720443476
Name:PETERSON, CARA (MSN, BSN, FNP-C, RN)
Entity type:Individual
Prefix:MS
First Name:CARA
Middle Name:
Last Name:PETERSON
Suffix:
Gender:
Credentials:MSN, BSN, FNP-C, RN
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:DEUTCHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3450 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6703
Mailing Address - Country:US
Mailing Address - Phone:734-664-6056
Mailing Address - Fax:248-243-8946
Practice Address - Street 1:3450 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6703
Practice Address - Country:US
Practice Address - Phone:734-664-6056
Practice Address - Fax:248-243-8946
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily