Individual
SHASTA PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2091 WALDRON DR, ANCHORAGE, AK 99507-1343
(208) 244-2962
Mailing address
PO BOX 231332, ANCHORAGE, AK 99523-1332
(208) 604-4263
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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