Provider Demographics
NPI:1487776258
Name:PETERSEN, JOSEPH A JR
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:PETERSEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 PFLUMM RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2407
Mailing Address - Country:US
Mailing Address - Phone:913-268-8969
Mailing Address - Fax:913-631-5443
Practice Address - Street 1:6600 PFLUMM RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66216-2407
Practice Address - Country:US
Practice Address - Phone:913-268-8969
Practice Address - Fax:913-631-5443
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant