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Tim Petersen — NPI 1689113680, Fairview, IL | NPI Central

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NPI 1689113680

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Tim Petersen

NPI 1689113680 · Driver · Fairview, IL

Provider details

NPI number: 1689113680
Entity type: Individual
Primary specialty: DriverOther Service Providers
Sex: Male
Sole proprietor: No
License: P362-8106-6065 (IL)

Specialties & taxonomies

DriverPrimary172A00000XLicense P362-8106-6065 (IL)
Other Service Providers

Practice location

32059 N State Route 97

Fairview, IL 61432-9643

Phone: (309) 414-2155

Approximate (ZIP-level) locationGet directions

More IL providers

Mailing address

32059 N State Route 97

Fairview, IL 61432-9643

Registry dates

Enumerated: 2017-02-23
Last updated: 2017-02-23

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.