Provider Demographics
NPI:1134634330
Name:PETERSEN, WHITNEY AMBER (PA-C)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:AMBER
Last Name:PETERSEN
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 1:2313 PAMELA LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0220
Mailing Address - Country:US
Mailing Address - Phone:406-396-0591
Mailing Address - Fax:
Practice Address - Street 1:5255 ELKHORN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842-2506
Practice Address - Country:US
Practice Address - Phone:916-334-1100
Practice Address - Fax:916-334-1105
Is Sole Proprietor?:No
Enumeration Date:2017-12-10
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006427363A00000X
CAPA59770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant