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General NPI Number Information
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NPI Number | 1790776425
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Entity Type | Individual
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Provider Name | LUCY ELIZABETH PETERSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 907 S PERRY ST
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City | SPOKANE
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State | WA
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Zip | 99202-3462
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Country | US
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Telephone | 509-838-3937
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8168
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City | SPOKANE
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State | WA
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Zip | 99203-0168
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Country | US
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Telephone | 509-838-3937
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 01082989A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD00031440
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License Number State | WA
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