Provider Demographics
NPI:1225676778
Name:PETERSEN, ALEXANDRA DEE
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DEE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13555 BOWMAN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3156
Mailing Address - Country:US
Mailing Address - Phone:530-885-3951
Mailing Address - Fax:
Practice Address - Street 1:13555 BOWMAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3156
Practice Address - Country:US
Practice Address - Phone:530-885-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant