Provider Demographics
NPI:1629510888
Name:PETERSON, NATASHA ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANNE
Last Name:PETERSON
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 1:122 W 7TH AVE STE 232
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2354
Mailing Address - Country:US
Mailing Address - Phone:509-455-2354
Mailing Address - Fax:509-277-7070
Practice Address - Street 1:122 W 7TH AVE STE 232
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2354
Practice Address - Country:US
Practice Address - Phone:509-455-2354
Practice Address - Fax:509-277-7070
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant