Healthcare Provider Details

I. General information

NPI: 1285130617
Provider Name (Legal Business Name): EMILY PETERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 E MERIDIAN PARK LOOP STE 3
WASILLA AK
99654-7255
US

IV. Provider business mailing address

3122 E MERIDIAN PARK LOOP STE 3
WASILLA AK
99654-7255
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-1113
  • Fax: 907-357-1110
Mailing address:
  • Phone: 907-357-1113
  • Fax: 907-357-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number44555
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number236245
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: