Individual
TIA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
435 N GATEWAY DR STE 801, PROVIDENCE, UT 84332-9004
(435) 787-1023
(435) 787-1882
Mailing address
435 N GATEWAY DR STE 801, PROVIDENCE, UT 84332-9004
(435) 787-1023
(435) 787-1882
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
324961-4405
UT
Other
Enumeration date
10/15/2015
Last updated
03/03/2023
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