Provider Demographics
NPI:1871276113
Name:PETERSEN, MEAGAN (APRN)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6027 COOKIE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-7729
Mailing Address - Country:US
Mailing Address - Phone:812-406-6808
Mailing Address - Fax:
Practice Address - Street 1:101 NOAHS LN
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5380
Practice Address - Country:US
Practice Address - Phone:812-282-8479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014199A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health