Individual
MR. LYNN A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, CRNA
Contact information
Practice address
714 W PINE ST, NEWPORT, WA 99156-9046
(509) 447-2441
(509) 447-2281
Mailing address
3412 S JEFFERSON DR, SPOKANE, WA 99203-1421
(509) 220-3834
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30006221
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9636465
—
WA
01
—
CG4026
RAILROAD GROUP NUMBER
WA
01
—
G000381050
MEDICARE GROUP NUMBER
WA
01
—
P00395894
MEDICARE RAILROAD
WA
Enumeration date
11/01/2006
Last updated
06/25/2019
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