Individual
PAUL E PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
447 W BEARCAT DR, SOUTH SALT LAKE, UT 84115-2519
(801) 355-2846
Mailing address
447 W BEARCAT DR, SOUTH SALT LAKE, UT 84115-2519
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
295118-3102
UT
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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