Individual
MRS. MADELYNE HALLE WILMA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
5910 NAUVOO LN, PASCO, WA 99301-6907
(206) 948-6745
Mailing address
1313 SHERWOOD ST, MISSOULA, MT 59802-2301
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/25/2017
Last updated
07/16/2020
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