Individual
GIDGET PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
901 9TH ST N, VIRGINIA, MN 55792-2329
(218) 741-0150
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-03146
NC
363A00000X
Physician Assistant
Primary
11015
MN
363A00000X
Physician Assistant
PA14874
CA
Other
Enumeration date
07/03/2006
Last updated
08/02/2019
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