Individual
MARIAH PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APP
Contact information
Practice address
1919 LINCOLN WAY STE 415, COEUR D ALENE, ID 83814-2527
(208) 625-4595
Mailing address
6225 N CORNWALL ST, COEUR D ALENE, ID 83815-5084
(661) 447-3670
(661) 447-3670
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
8771254
ID
Other
Enumeration date
05/02/2025
Last updated
05/02/2025
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