Healthcare Provider Details

I. General information

NPI: 1629510888
Provider Name (Legal Business Name): NATASHA ANNE PETERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ROCKEFELLER AVE STE 310
EVERETT WA
98201-1677
US

IV. Provider business mailing address

122 W 7TH AVE STE 232
SPOKANE WA
99204-2354
US

V. Phone/Fax

Practice location:
  • Phone: 425-316-5490
  • Fax:
Mailing address:
  • Phone: 509-455-2354
  • Fax: 509-277-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60710653
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: