Provider Demographics
NPI:1962562231
Name:PETERSEN, JENNY LYNN (RN)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1665 OLD HOT SPRINGS RD
Mailing Address - Street 2:SUITE 157
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0782
Mailing Address - Country:US
Mailing Address - Phone:775-687-5162
Mailing Address - Fax:775-687-1214
Practice Address - Street 1:1825 PINION RD
Practice Address - Street 2:STE A
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8318
Practice Address - Country:US
Practice Address - Phone:775-738-8021
Practice Address - Fax:775-738-8842
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVRN49340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse