Individual
ANISSA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1111 TENEYCK ST STE 100, JACKSON, MI 49201-2493
(517) 205-8940
(517) 205-0108
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011567
MI
Other
Enumeration date
08/24/2022
Last updated
10/06/2025
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