Mr. WILEY D PETERSEN PA-C
Individual Provider (NPI-1)
Active
Physician Assistant
Provider Information
- NPI Number
1568920080- Provider Type
- Individual Provider (NPI-1)
- Credentials
- PA-C
- Status
- Active
Contact & Location
- Address
- 134 W CHUBBUCK RD, CHUBBUCK, ID, 832022338
- Phone
- (208) 417-0102
- Fax
- (208) 242-3219
Specialties & Taxonomies
Physician Assistant
Primary License: ID #PA-1714