Individual
TATIANA LVOVNA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2121 NE 139TH ST, VANCOUVER, WA 98686-2316
(360) 487-1000
(360) 487-5239
Mailing address
2121 NE 139TH ST, VANCOUVER, WA 98686-2316
(360) 487-1000
(360) 487-5239
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00042246
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8374563
—
WA
Enumeration date
01/19/2007
Last updated
06/03/2009
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