Individual
MACHELLE F. PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
468 LONESOME DOVE LN, TENSED, ID 83870-8387
(208) 874-3095
Mailing address
PO BOX 93, TENSED, ID 83870-0093
(208) 874-3095
(833) 900-1404
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
61016081
WA
367A00000X
Advanced Practice Midwife
Primary
62928
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62928
CNM PROVIDER LICENSE
ID
Enumeration date
10/17/2019
Last updated
11/06/2023
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