Individual
MARC ZEPHIRE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
101 CIVIC CENTER LANE, HAVASU REGIONAL MEDICAL CENTER, LAKE HAVASU, AZ 86403
(928) 505-5760
Mailing address
2770 SQUALL KING DR, LAKE HAVASU CITY, AZ 86404-3304
(801) 870-3968
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
14-126823-061
KS
163W00000X
Registered Nurse
5909731-3102
UT
163W00000X
Registered Nurse
RN202234
AZ
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA1248
AZ
Other
Enumeration date
09/01/2016
Last updated
11/08/2016
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