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Pat Quinn, Governor Julie Amos, Director 201 South Grand Avenue East Springfield, Illinois 627630002 Telephone: 12177820545 TTY: 18005265812 Informational Notice Date: November 30, 2012, To: Long
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Informational notice - formspetersenhealthcarenet is a form used to report important information to Petersen Healthcare.
All healthcare providers affiliated with Petersen Healthcare are required to file the informational notice form.
To fill out the informational notice form, providers must enter the required information accurately and completely.
The purpose of the informational notice form is to ensure that Petersen Healthcare has up-to-date information on its affiliated providers.
Providers must report their contact information, services offered, and any changes in their practice.
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