Individual
PAMELA B PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2360 MULLAN RD STE C, MISSOULA, MT 59808-1811
(406) 721-4436
(406) 542-1037
Mailing address
2360 MULLAN RD STE C, MISSOULA, MT 59808-1811
(406) 721-4436
(406) 542-1037
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN18519
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000372730
BLUE CROSS BLUE SHIELD
MT
05
—
0439998
—
MT
01
—
500027942 CK5082
RAILROAD MEDICARE
—
05
—
806516800
—
ID
Enumeration date
02/14/2007
Last updated
08/26/2014
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