Individual
LISA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1500 E SHERMAN BLVD, MUSKEGON, MI 49444-1849
(231) 739-9341
Mailing address
PO BOX 673397, DETROIT, MI 48267-3397
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005897
MI
Other
Enumeration date
09/23/2010
Last updated
02/24/2011
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