MEDICARE: BRIDGETT EILEEN PETERS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	00749	IA
2	363A00000X	Physician Assistant	000749	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28313	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1881676757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETT EILEEN PETERS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 2027
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52244-2027
Country	:	US
Telephone Number	:	319-339-3451
Fax Number	:	319-358-2737

Provider Business Practice Location Address
First Line	:	540 E JEFFERSON ST
Second Line	:	SUITE 400
City	:	IOWA CITY
State	:	IA
Zip	:	52245-2477
Country	:	US
Telephone Number	:	319-339-3400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	06/29/2015

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Directions to “ BRIDGETT EILEEN PETERS PA-C” Practice Location

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