Individual
CHRISTINE ELIZABETH PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200703
LA
363AS0400X
Surgical Physician Assistant
013332
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09886738
—
MS
05
—
2366629
—
LA
Enumeration date
07/06/2009
Last updated
12/19/2014
Update your record
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