Tim Petersen is a Driver based in Fairview, IL. Tim Petersen practices in Fairview, IL. The NPI Number for Tim Petersen is 1689113680 and holds a License No. P362-8106-6065 (Illinois).
The current practice location address for Tim Petersen is 32059 N State Route 97, Fairview, IL and can be reached out via phone at 309-414-2155.
Location: 32059 N State Route 97, Fairview, IL, 61432-9643
Provider Profile Details
NPI Number
1689113680
Provider Name
Tim Petersen
Credential
Provider Entity Type
Individual
Gender
Male
Address
32059 N State Route 97, Fairview, IL, 61432-9643
Phone Number
309-414-2155
Fax Number
Provider Enumeration Date
02/23/2017
Last Update Date
03/09/2024
Provider Business Practice Location Address Details
Address
32059 N State Route 97
City
State
Zip
61432-9643
Phone Number
309-414-2155
Fax Number
Provider Business Mailing Address Details
Address
32059 N State Route 97
City
State
Zip
61432-9643
Phone Number
309-414-2155
Fax Number
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Driver
Speciality
-
Taxonomy
License No.
P362-8106-6065 (Illinois)
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
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