Individual
LORI PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
518 S 13TH ST, COEUR D ALENE, ID 83814-3919
(509) 953-1000
(509) 458-6087
Mailing address
PO BOX 2145, SPOKANE, WA 99210-2145
(509) 953-1000
(509) 458-6087
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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