Provider Demographics
NPI:1760260020
Name:PETERSEN, ELSABETH (LAC)
Entity Type:Individual
Prefix:DR
First Name:ELSABETH
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SE CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-6443
Mailing Address - Country:US
Mailing Address - Phone:360-607-3642
Mailing Address - Fax:
Practice Address - Street 1:1615 SE CASCADE AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-6443
Practice Address - Country:US
Practice Address - Phone:360-607-3642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC218011171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist