Individual
AMY S PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
805 4TH AVE DR, JEROME, ID 83338-2104
(208) 308-1350
(208) 324-9628
Mailing address
805 4TH AVE DR, JEROME, ID 83338-2104
(208) 308-1350
(208) 324-9628
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
101-17560
VA
Other
Enumeration date
03/26/2013
Last updated
03/26/2013
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