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General NPI Number Information
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NPI Number | 1053824722
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Entity Type | Individual
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Provider Name | BRIGITTE PETERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 171 CAMPBELL LN
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City | YERINGTON
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State | NV
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Zip | 89447-9768
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Country | US
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Telephone | 775-783-0222
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Fax | 775-463-5925
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Provider Business Mailing Address
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Address Line | 8096 ANSELMO CT
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City | RENO
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State | NV
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Zip | 89523-8992
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Country | US
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Telephone | 775-343-6249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1484
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License Number State | NV
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