Individual
MIRANDA PETRUSKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 E 8TH ST, PORT ANGELES, WA 98362-6129
(360) 457-0431
(360) 457-0493
Mailing address
118 E 8TH ST, PORT ANGELES, WA 98362-6129
(360) 457-0431
(360) 457-0493
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MDH0157
—
AK
Enumeration date
11/21/2011
Last updated
05/01/2024
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