Individual
GLENN ADAM PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
19835 10TH AVE NE STE B, POULSBO, WA 98370-7451
(360) 779-7011
Mailing address
28595 GAMBLE BAY RD NE, KINGSTON, WA 98346-9503
(618) 550-9746
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085006213
IL
363A00000X
Physician Assistant
Primary
PA61047355
WA
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/25/2017
Last updated
07/21/2022
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