Individual
MR. SHAUN M PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2310 N 400 E, STE A, NORTH LOGAN, UT 84341-1788
(435) 787-2000
(435) 787-1913
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 890-9466
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7036833-1206
UT
Other
Enumeration date
07/29/2008
Last updated
10/01/2021
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