Provider Demographics
NPI:1639583552
Name:PETERSON, JOY MAUNEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:MAUNEY
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 1:516 LAUSANNE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5243
Mailing Address - Country:US
Mailing Address - Phone:336-299-7358
Mailing Address - Fax:336-852-9151
Practice Address - Street 1:516 LAUSANNE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5243
Practice Address - Country:US
Practice Address - Phone:336-299-7358
Practice Address - Fax:336-852-9151
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant