Individual
MRS. JOHANNA RAE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2200 NE NEFF RD STE 302, BEND, OR 97701-4279
(541) 706-4220
Mailing address
PO BOX 1188, CORVALLIS, OR 97339-1188
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01280
OR
Other
Enumeration date
10/16/2007
Last updated
09/17/2024
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