Provider Demographics
NPI:1053824722
Name:PETERSON, BRIGITTE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRIGITTE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8096 ANSELMO CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-8992
Mailing Address - Country:US
Mailing Address - Phone:775-343-6249
Mailing Address - Fax:
Practice Address - Street 1:171 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-9768
Practice Address - Country:US
Practice Address - Phone:775-783-0222
Practice Address - Fax:775-463-5925
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant