Individual
JEANNE LYNN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
201 S 4TH AVE, INTAKE PROVIDER, PHOENIX, AZ 85003-2138
(602) 876-9124
(602) 253-3431
Mailing address
201 S 4TH AVE, PHOENIX, AZ 85003-2138
(602) 876-9124
(602) 253-3431
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5187
AZ
Other
Enumeration date
08/29/2012
Last updated
05/05/2020
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