Individual provider · Type 1 NPI

Jennifer Louise Petersen, NURSE PRACTITIONER

Family Nurse Practitioner · Fort Drum, NY

NPI number 1629053343 Active

Practice location

11050 Mount Belvedere Blvd, Usa Meddac Attn: Credentials
Fort Drum, NY 13602-5438

Fax (315) 772-9498

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner Primary 363LF0000X44888 (KS)

Family Nurse Practitioner: Definition to come...

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About NPI 1629053343

Jennifer Louise Petersen, NURSE PRACTITIONER's National Provider Identifier is 1629053343, issued on Dec 15, 2005. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Fort Drum, NY. The record was last updated on Jul 13, 2026.