Provider Demographics
NPI:1538598495
Name:PETERKIN, NETTIE (RN)
Entity type:Individual
Prefix:
First Name:NETTIE
Middle Name:
Last Name:PETERKIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 EASTERN PKWY
Mailing Address - Street 2:APT B1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4147
Mailing Address - Country:US
Mailing Address - Phone:347-986-6177
Mailing Address - Fax:
Practice Address - Street 1:1196 EASTERN PKWY
Practice Address - Street 2:APT B1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4147
Practice Address - Country:US
Practice Address - Phone:347-986-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY667038163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse