Individual
MR. DEVON D PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3043 NE 28TH ST, LINCOLN CITY, OR 97367-4518
(541) 994-3661
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
10004847
OR
367500000X
Certified Registered Nurse Anesthetist
53425214406
UT
Other
Enumeration date
06/03/2006
Last updated
07/27/2023
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