Individual
STEPHANIE C PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7182 WOODROW ST STE 200, IRMO, SC 29063-2958
(803) 749-1111
(803) 749-0050
Mailing address
7182 WOODROW ST STE 200, IRMO, SC 29063-2958
(803) 749-1111
(803) 749-0050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1204
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117698
—
SC
01
—
SC1204
SC MEDICAL LICENSE
SC
Enumeration date
04/17/2007
Last updated
06/19/2024
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