Individual
THUY LE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1300 METROPOLITAN AVE, LEAVENWORTH, KS 66048
(913) 682-8700
Mailing address
5715 N HULL CT, KANSAS CITY, MO 64151-2602
(260) 418-3972
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1089316
MO
363AS0400X
Surgical Physician Assistant
1089316
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1089316
MISSOURI LICENSE NUMBER
MO
Enumeration date
10/02/2009
Last updated
07/11/2019
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