| NPI | 1518303189 |
|---|---|
| Former Name | CARLY E PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005999) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006662) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2023-04-03 |