Provider Demographics
NPI:1447221213
Name:PETERSEN, ROBIN ELAINE (RN FNP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:ELAINE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 HURLEY WAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3215
Mailing Address - Country:US
Mailing Address - Phone:916-564-3040
Mailing Address - Fax:916-564-3065
Practice Address - Street 1:150 CATHERINE LN
Practice Address - Street 2:# D
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5719
Practice Address - Country:US
Practice Address - Phone:530-477-8358
Practice Address - Fax:530-477-2015
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12010363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP20832Medicare UPIN
CAGR0045980Medicaid
P20832Medicare UPIN