| Doctor Name: | MR. JOSEPH D PETERSEN |
| NPI Number: | 1467603266 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ARNP |
| License Number: | IP60045993 |
| Business Practice Address: | 208 Cedar Creek Terrace Ione, WA - 99139 |
| Business Phone Number: | 5094423514 |
| Business Fax Number: | 5094423436 |
| Mailing Address: | Po Box 808, CHEWELAH |
| State: | WA |
| Postal Code: | 991090808 |
| Phone Number: | 5099356001 |
| Fax Number: | |
| NPI Enumeration Date: | 10/10/2008 |
| NPI Last Update Date: | 10/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | IP60045993 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |