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General NPI Number Information
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NPI Number | 1063514628
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Entity Type | Individual
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Provider Name | BRIDGET IONE PETERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/03/2006
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 34 MAPLE ST
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City | NORWALK
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State | CT
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Zip | 06850-3815
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Country | US
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Telephone | 203-852-2188
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Fax |
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Provider Business Mailing Address
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Address Line | 37-39 FERRIS AVE APT. 16
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City | NORWALK
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State | CT
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Zip | 06854-1551
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Country | US
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Telephone | 720-840-8839
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 001806
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License Number State | CT
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