Provider Demographics
NPI:1144743360
Name:PETERSON, ANASTASIA LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:LEIGH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:SKROBISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2733 SW 21ST CIR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4245
Mailing Address - Country:US
Mailing Address - Phone:847-732-3024
Mailing Address - Fax:
Practice Address - Street 1:5200 100TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7208
Practice Address - Country:US
Practice Address - Phone:515-695-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088285207P00000X, 2082S0099X, 261QU0200X, 363AM0700X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical