Provider Demographics
NPI:1275512451
Name:PETERSEN, KERRI (ARNP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:LANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:316 W BOONE AVE
Mailing Address - Street 2:SUITE 757
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2354
Mailing Address - Country:US
Mailing Address - Phone:509-868-0876
Mailing Address - Fax:509-385-0670
Practice Address - Street 1:316 W BOONE AVE
Practice Address - Street 2:SUITE 757
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2354
Practice Address - Country:US
Practice Address - Phone:509-868-0876
Practice Address - Fax:509-385-0670
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner