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General NPI Number Information
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NPI Number | 1811406267
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Entity Type | Individual
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Provider Name | CHRISTINA STAR PETERSEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 100 BUREAU DRIVE BLDG 101, RM C-33, MS #1732
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City | GAITHERSBURG
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State | MD
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Zip | 20899-0001
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Country | US
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Telephone | 301-975-5131
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Fax |
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Provider Business Mailing Address
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Address Line | 590 MEDICAL CENTER ROAD BLDG # 36065
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City | FT. HOOD
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State | TX
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Zip | 76544-5060
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Country | US
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Telephone | 254-553-4196
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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 | C06578
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License Number State | MD
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