Individual
JAMIE BROOKE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10394 W HENRYS LAKE DR, BOISE, ID 83709-6283
(208) 440-0255
(208) 231-3371
Mailing address
1325 NE 7TH ST, GRANTS PASS, OR 97526-1358
(541) 460-5331
(541) 460-5165
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1236
ID
Other
Enumeration date
02/04/2014
Last updated
10/22/2024
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