1376141101 NPI number — VIRGINIA ANN PETERSON FNP-C

Table of content: VIRGINIA ANN PETERSON FNP-C (NPI 1376141101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376141101 NPI number — VIRGINIA ANN PETERSON FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSON
Provider First Name:
VIRGINIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERSON
Provider Other First Name:
GINGER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1376141101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HOSPITAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEROKEE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28719-9253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-640-4044
Provider Business Mailing Address Fax Number:
770-640-4040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 CLEAR CREEK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-640-4044
Provider Business Practice Location Address Fax Number:
770-640-4040
Provider Enumeration Date:
10/14/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5012987 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN077342 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)