Provider Demographics
NPI:1861207870
Name:PETERSEN, KAREN STELLA
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:STELLA
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56588 839 RD
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68779-2028
Mailing Address - Country:US
Mailing Address - Phone:402-750-1410
Mailing Address - Fax:
Practice Address - Street 1:56588 839 RD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:NE
Practice Address - Zip Code:68779-2028
Practice Address - Country:US
Practice Address - Phone:402-750-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE377237913747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant