| NPI | 1053387522 |
|---|---|
| Former Name | AMY L PETERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 0598) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD L1728) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2010-05-26 |