| NPI | 1023127271 |
|---|---|
| Former Name | PAMELA JEAN PETERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX K7864) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 044746) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-12-11 |