Individual
JENNIFER C PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
075484
GA
2080P0203X
Pediatric Critical Care Medicine Physician
13205
ND
2080P0203X
Pediatric Critical Care Medicine Physician
53734
WI
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
71077
AZ
208M00000X
Hospitalist Physician
71077
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81315
—
ND
Enumeration date
07/21/2008
Last updated
08/06/2025
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