Healthcare Provider Details

I. General information

NPI: 1144743360
Provider Name (Legal Business Name): ANASTASIA LEIGH PETERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANASTASIA SKROBISH

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 100TH ST
URBANDALE IA
50322-7208
US

IV. Provider business mailing address

2733 SW 21ST CIR
ANKENY IA
50023-4245
US

V. Phone/Fax

Practice location:
  • Phone: 515-695-7500
  • Fax:
Mailing address:
  • Phone: 847-732-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number088285
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number088285
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number088285
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number088285
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number088285
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: