Provider Demographics
NPI:1730215963
Name:PETERS, CAROL JEAN (NPBSN,MSN)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JEAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:NPBSN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7549 HILLMONT DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2931
Mailing Address - Country:US
Mailing Address - Phone:510-562-9628
Mailing Address - Fax:
Practice Address - Street 1:830 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2044
Practice Address - Country:US
Practice Address - Phone:510-981-5350
Practice Address - Fax:510-981-6385
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279429261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility