Provider Demographics
NPI:1659414449
Name:PETERS, MARIAN JEAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:JEAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:132 POPLAR GROVE CONNECTOR
Practice Address - Street 2:SUITE B
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5915
Practice Address - Country:US
Practice Address - Phone:828-264-8759
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2022-05-17
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Provider Licenses
StateLicense IDTaxonomies
NC0010-00240363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant