# DR. ELIZA S. PETERSEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1083750996
- **Gender:** F
- **Credential:** AUD, CCCA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | A-974 | WY | — |
| 231H00000X | Audiologist | AUD-1142 | ID | Yes |

## Other

- **Enumeration date:** 01/29/2007
- **Last updated:** 04/19/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 125563100 | — | WY |
| 05 | — | 807694600 | — | ID |