Individual
AMANDA D PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4804 W CLEARWATER AVE, KADLEC CLINIC URGENT CARE, KENNEWICK, WA 99336
(509) 942-2355
(509) 222-2355
Mailing address
3900 S ZINTEL WAY, KENNEWICK, WA 99337
(509) 942-3627
(509) 942-2268
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA60113833
WA
363AM0700X
Medical Physician Assistant
PENDING
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528391372
—
WA
Enumeration date
09/11/2009
Last updated
01/22/2014
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