| NPI | 1619169919 |
|---|---|
| Former Name | HEATHER PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2385) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA17901) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2026-01-09 |