Individual
GINA RENEE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
330 E BELTLINE AVE NE, SUITE 100, GRAND RAPIDS, MI 49506-1267
(616) 752-6235
(616) 328-8176
Mailing address
330 E BELTLINE AVE NE, SUITE 100, GRAND RAPIDS, MI 49506-1267
(616) 752-6235
(616) 328-8176
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006479
MI
Other
Enumeration date
09/17/2012
Last updated
10/30/2015
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