Provider Demographics
NPI:1881676757
Name:PETERS, BRIDGETT EILEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:EILEEN
Last Name:PETERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3451
Mailing Address - Fax:319-358-2737
Practice Address - Street 1:540 E JEFFERSON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2477
Practice Address - Country:US
Practice Address - Phone:319-339-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00749363A00000X
IA000749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28313OtherWELLMARK BCBS
IAI1759Medicare PIN
IA970018673Medicare PIN
S34238Medicare UPIN