Provider Demographics
NPI:1659604247
Name:PETERSON, ALISON M (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:M
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:M
Other - Last Name:PETETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:16611 S. 40TH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048
Mailing Address - Country:US
Mailing Address - Phone:480-610-6366
Mailing Address - Fax:480-833-1653
Practice Address - Street 1:16611 S. 40TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048
Practice Address - Country:US
Practice Address - Phone:480-610-6366
Practice Address - Fax:480-833-1653
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4456363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical