Provider Demographics
NPI:1841381068
Name:PETERSON, GAIL A (ARNP, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:A
Last Name:PETERSON
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S GRADY WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3246
Mailing Address - Country:US
Mailing Address - Phone:509-797-1889
Mailing Address - Fax:
Practice Address - Street 1:411 FORTUYN RD
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133-8718
Practice Address - Country:US
Practice Address - Phone:509-633-1753
Practice Address - Fax:509-633-1933
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006440363LF0000X
WAAP3006440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1022320Medicaid
WAG8900106OtherCMC MDCR PTAN
Q07925Medicare UPIN
8801301Medicare ID - Type Unspecified