Individual
GLENDA A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHN
Contact information
Practice address
16110 SW REGATTA LN, BEAVERTON, OR 97006-8942
(503) 629-2131
(503) 617-9379
Mailing address
PO BOX 42510, PORTLAND, OR 97242-0510
(503) 963-1290
(503) 230-1541
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
079039861N6
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115218
MANAGED HEALTH
—
Enumeration date
07/25/2006
Last updated
07/08/2007
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