Individual
JACQUELYN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
320 PRATHER AVE, JAMESTOWN, NY 14701-6820
(716) 753-7107
Mailing address
95 E CHAUTAUQUA ST, PO BOX 168, MAYVILLE, NY 14757-1017
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
007012
NY
Other
Enumeration date
11/01/2005
Last updated
06/15/2021
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