Julie Petersen
Contractor in Council Bluffs, IA. Individual provider (NPI-1).
NPI number1669242004
StatusActive
Last updated in NPPESJan 8, 2024
Details
- NPI
- 1669242004
- Entity type
- Individual (NPI-1)
- Name
- Julie Petersen
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jan 8, 2024
- Certification date
- Jan 6, 2024
- Last updated
- Jan 8, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171W00000X | Contractor | – | – | Yes |
| 171M00000X | Case Manager/Care Coordinator | – | – | |
| 174400000X | Specialist | – | – | |
| 246Y00000X | Spec/Tech, Health Info | – | – |
Practice location
20203 Lynn LnCouncil Bluffs, IA 51503-2512
Phone 712-310-4727
Mailing address
20203 Lynn LnCouncil Bluffs, IA 51503-2512
Phone 712-310-4727
Is something wrong?
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