Provider Demographics
NPI:1962638429
Name:PETERSON, KAREN SUE (RD LDN CDE)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RD LDN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-5701
Mailing Address - Country:US
Mailing Address - Phone:724-498-6545
Mailing Address - Fax:724-598-3425
Practice Address - Street 1:191 ELEANOR DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-5701
Practice Address - Country:US
Practice Address - Phone:724-498-6545
Practice Address - Fax:724-598-3425
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000768133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102439288Medicaid
PA102439288Medicaid