Individual
BRIDGET IONE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
34 MAPLE ST, NORWALK, CT 06850-3815
(203) 852-2188
Mailing address
37-39 FERRIS AVE, APT. 16, NORWALK, CT 06854-1551
(720) 840-8839
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
001806
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001806
LICENSE NUMBER
CT
Enumeration date
09/03/2006
Last updated
12/08/2010
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