Provider Demographics
NPI:1679692255
Name:PETERSON, ALTARI SUNRA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:ALTARI
Middle Name:SUNRA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14123 N DEER LN
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9273
Mailing Address - Country:US
Mailing Address - Phone:509-466-3822
Mailing Address - Fax:509-466-3577
Practice Address - Street 1:1016 N SUPERIOR ST
Practice Address - Street 2:RM 9
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2059
Practice Address - Country:US
Practice Address - Phone:509-953-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist