Individual
GLORIA LYNN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
610 S LINCOLN RD, ESCANABA, MI 49829-1215
(906) 786-6488
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005854
MI
363A00000X
Physician Assistant
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1094325
NCCPA
—
Enumeration date
08/26/2010
Last updated
07/12/2023
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