Doctor Name: | JENNIFER PETERSON |
NPI Number: | 1144605171 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 6103 |
Business Practice Address: | 625 N Plaza Dr Apache Junction, AZ - 851205501 |
Business Phone Number: | 4809830065 |
Business Fax Number: | 4802885339 |
Mailing Address: | 625 N Plaza Dr, APACHE JUNCTION |
State: | AZ |
Postal Code: | 851205501 |
Phone Number: | 4809830065 |
Fax Number: | 4802885339 |
NPI Enumeration Date: | 07/20/2015 |
NPI Last Update Date: | 07/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 6103 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |