Healthcare Provider Details

I. General information

NPI: 1407780042
Provider Name (Legal Business Name): SIENNA PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 W PARKSTONE LN APT 101
MERIDIAN ID
83646-1989
US

IV. Provider business mailing address

735 W PARKSTONE LN APT 101
MERIDIAN ID
83646-1989
US

V. Phone/Fax

Practice location:
  • Phone: 208-740-0495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: