| Doctor Name: | MRS. MICHELE JENNEFER PETERSON |
| NPI Number: | 1508924481 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.M.P. |
| License Number: | MA00022514 |
| Business Practice Address: | 34730 Pacific Hwy S Federal Way, WA - 980036821 |
| Business Phone Number: | 2538740198 |
| Business Fax Number: | 2538740408 |
| Mailing Address: | 918 Sw 314th Pl, FEDERAL WAY |
| State: | WA |
| Postal Code: | 980234523 |
| Phone Number: | 2539450609 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MA00022514 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |