WILEY D PETERSEN

CHUBBUCK, ID
NPI1568920080
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA-1714)
Enumeration Date2019-03-04
Last Update Date2024-05-17
Business Address
Mr. WILEY D PETERSEN PA-C
134 W CHUBBUCK RD
CHUBBUCK, ID 83202-2338
Phone number: 208-417-0102
Mailing Address
Mr. WILEY D PETERSEN PA-C
5014 MARY LN
POCATELLO, ID 83202-1679
Phone number: 208-241-5819
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