Provider Demographics
NPI:1861749442
Name:PETERS, MAUREEN (ANP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 CENTER DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3017
Mailing Address - Country:US
Mailing Address - Phone:619-828-1000
Mailing Address - Fax:619-828-1001
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:SUITE 208
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-828-1000
Practice Address - Fax:619-828-1001
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21924363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health