Individual
ANNA LIND PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6360 S 3000 E, STE 100, SALT LAKE CITY, UT 84121-6923
(801) 365-1032
(801) 365-1036
Mailing address
2295 FOOTHILL DR, SALT LAKE CITY, UT 84109-4000
(801) 486-3021
(801) 485-6339
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4985588-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4985588-1206
UT STATE LICENSE
UT
Enumeration date
09/21/2007
Last updated
11/11/2021
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