Individual provider · Type 1 NPI
Tim Petersen
Driver · Fairview, IL
NPI number
1689113680
Active
Practice location
32059 N State Route 97
Fairview, IL 61432-9643
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Driver Primary | 172A00000X | P362-8106-6065 (IL) |
Driver: A person employed to operate a motor vehicle as a carrier of persons or property.
About NPI 1689113680
Tim Petersen's National Provider Identifier is 1689113680, issued on Feb 23, 2017. The primary taxonomy on file is Driver (172A00000X), and the practice location is in Fairview, IL. The record was last updated on Feb 23, 2017.