Provider Demographics
NPI:1366168551
Name:PETERS, LADONNA LILLIAN (DNP, AGACNP)
Entity type:Individual
Prefix:DR
First Name:LADONNA
Middle Name:LILLIAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:DNP, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31460 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4513
Mailing Address - Country:US
Mailing Address - Phone:313-657-1878
Mailing Address - Fax:
Practice Address - Street 1:31460 KELLY RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4513
Practice Address - Country:US
Practice Address - Phone:313-657-1878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215290363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care