Individual
LISA M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1500 14TH ST W STE 300, WILLISTON, ND 58801-4079
(701) 774-7500
(701) 774-3918
Mailing address
1500 14TH ST W STE 300, WILLISTON, ND 58801-4079
(701) 774-7500
(701) 774-3918
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PAC0377
ND
363AS0400X
Surgical Physician Assistant
Primary
PAC0377
ND
Other
Enumeration date
10/29/2007
Last updated
07/21/2022
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