Provider Demographics
NPI:1487755823
Name:PETERSON, JEANNE LOUISE (CNM)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:LOUISE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:LOUISE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3328
Mailing Address - Country:US
Mailing Address - Phone:307-682-6263
Mailing Address - Fax:
Practice Address - Street 1:30 LUNA DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-8910
Practice Address - Country:US
Practice Address - Phone:307-250-9122
Practice Address - Fax:866-652-1064
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY824367A00000X
SDCM000018367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY23337.0824OtherCERTIFIED NURSE MIDWIFE
WY23337.0824OtherCERTIFIED NURSE MIDWIFE
WY23337.0824OtherCERTIFIED NURSE MIDWIFE