Most Relevant Information
Provider Data
| NPI Number: | 1003698507 |
| Provider Name: | MADELIENE ALEXANDRA PETERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 12058297-3102 |
Most Important Dates
| Enumeration Date: | 10/18/2023 |
| Last Updated: | 12/26/2023 |
Provider Practice Location
170 N 1100 E
AMERICAN FORK
UT
840032961
Practice Location Phone/Fax
| Phone: | 8018553267 |
| Fax: | 8018553251 |
Provider Mailing Location
2221 LAKESIDE BLVD STE 600
RICHARDSON
TX
750824416
Provider Mailing Phone/Fax
| Phone: | 4695051652 |
| Fax: | 4694363976 |