Individual
DR. ELIZA S. PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AUD, CCCA
Contact information
Practice address
2740 SHADOWMOON LN STE 417, DRIGGS, ID 83422-5083
(307) 745-5587
(877) 515-1633
Mailing address
1388 MOUNT MORIAH RD, LIVERMORE, CO 80536-9311
(307) 745-5587
(877) 515-1633
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
A-974
WY
231H00000X
Audiologist
Primary
AUD-1142
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125563100
—
WY
05
—
807694600
—
ID
Enumeration date
01/29/2007
Last updated
04/19/2023
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