Provider Demographics
NPI:1346448248
Name:PETERSEN, KAREN A (CHP, LMP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:CHP, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 BROOKLYN AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3517
Mailing Address - Country:US
Mailing Address - Phone:206-328-5143
Mailing Address - Fax:206-525-5351
Practice Address - Street 1:5505 BROOKLYN AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3517
Practice Address - Country:US
Practice Address - Phone:206-328-5143
Practice Address - Fax:206-525-5351
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008947174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0107673OtherLABOR&INDUSTRIESPROVIDER#
WAPE5492OtherREGENCEPROVIDER#
WAMA00008947OtherMASSAGE LICENCE #