Provider Demographics
NPI:1730414012
Name:PETERSON, CAROL A (ICCE, CD(DONA))
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:PETERSON
Suffix:
Gender:F
Credentials:ICCE, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-4411
Mailing Address - Country:US
Mailing Address - Phone:814-899-7722
Mailing Address - Fax:
Practice Address - Street 1:2465 CLARK RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-4411
Practice Address - Country:US
Practice Address - Phone:814-899-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula