Healthcare Provider Details

I. General information

NPI: 1285725895
Provider Name (Legal Business Name): DEBRA DIANE PETERSON PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 EAST 7TH AVE SUITE D
CHICO CA
95926
US

IV. Provider business mailing address

185 EAST 7TH AVE SUITE D
CHICO CA
95926
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-7564
  • Fax: 530-342-7585
Mailing address:
  • Phone: 530-342-7564
  • Fax: 530-342-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: