Individual
PAMELA TERESA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
300 W WASHINGTON AVE, SUITE 300, JACKSON, MI 49201-2180
(517) 841-1305
(517) 841-1306
Mailing address
PO BOX 670884, DETROIT, MI 48267-0884
(800) 999-5829
(248) 641-4840
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704194081
MI
363LA2100X
Acute Care Nurse Practitioner
Primary
4704194081
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255371530
—
MI
01
—
P00252787
RR MEDICARE
MI
Enumeration date
06/07/2006
Last updated
09/08/2025
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