Individual
KIMBERLY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10180 SE SUNNYSIDE ROAD, CLACKAMAS, OR 97015
(503) 652-2880
Mailing address
1963 NW IRVING ST APT 206, PORTLAND, OR 97209
Taxonomy
Speciality
Code
Description
License number
State
2278C0205X
Critical Care Certified Respiratory Therapist
Primary
10132017
OR
Other
Enumeration date
05/28/2010
Last updated
05/28/2010
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