Most Relevant Information
Provider Data
| NPI Number: | 1003682477 |
| Provider Name: | TIARA JANAYE PETERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/28/2023 |
| Last Updated: | 08/01/2024 |
Provider Practice Location
3005 BLADENSBURG RD NE
WASHINGTON
DC
200182265
Practice Location Phone/Fax
| Phone: | 2029043185 |
| Fax: |
Provider Mailing Location
3005 BLADENSBURG RD NE
WASHINGTON
DC
200182265
Provider Mailing Phone/Fax
| Phone: | 2029043185 |
| Fax: |