MR. JAY WADEMAN PETERSON CNP NPI 1821012386

NPI Information

  • NPI: 1821012386
  • Provider Name: MR. JAY WADEMAN PETERSON, CNP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • Address: 201 CEDAR ST SE
    STE 800
    ALBUQUERQUE, NM
    ZIP 87106
  • Phone: (505) 563-2800

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NPI Details

MR. Jay Wademan Peterson, CNP is a family nurse practitioner in Albuquerque, NM. MR. Jay Wademan Peterson, CNP NPI is 1821012386. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

201 CEDAR ST SE
STE 800
ALBUQUERQUE, NM
ZIP 87106-917
Phone: (505) 563-2800
Fax: (505) 563-2821

The enumeration date for this NPI number is 7/27/2006 and was last updated on 10/23/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyR48991NEW MEXICOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1Q13603MEDICARE UPINNEW MEXICO
247737352MEDICAIDNEW MEXICO
3349536205MEDICARE ID-TYPE UNSPECIFIEDNEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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