Individual
JAIME M PETERSON
Active
Individual
JAIME M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1685
WI
363AM0700X
Medical Physician Assistant
2124
IA
363AS0400X
Surgical Physician Assistant
1685
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41984800
—
WI
Enumeration date
06/14/2005
Last updated
07/10/2015
Update your record
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