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Individual
MARY T CARR PETERSON
Active
Individual
MARY T CARR PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001597
IA
363AM0700X
Medical Physician Assistant
001597
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0634600
—
IA
05
—
1117994
—
IA
05
—
2117994
—
IA
05
—
3117994
—
IA
01
—
37902
WELLMARK
—
01
—
37903
WELLMARK
—
01
—
37904
WELLMARK
—
01
—
37905
WELLMARK
—
Enumeration date
02/15/2006
Last updated
08/07/2025
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