Provider Demographics
NPI:1578440616
Name:PETERSON, DESTINY (CNA, HHA)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CNA, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1303
Mailing Address - Country:US
Mailing Address - Phone:712-224-0022
Mailing Address - Fax:
Practice Address - Street 1:412 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1414
Practice Address - Country:US
Practice Address - Phone:712-355-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide