| NPI | 1588997308 |
|---|---|
| Former Name | LAURA M PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2505) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WI 2505-23) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2023-03-14 |