Provider Demographics
NPI:1356516009
Name:PETERSON, SHARLA KAY (ARNP)
Entity type:Individual
Prefix:
First Name:SHARLA
Middle Name:KAY
Last Name:PETERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6443 NE 181ST ST
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4831
Mailing Address - Country:US
Mailing Address - Phone:425-424-2100
Mailing Address - Fax:
Practice Address - Street 1:6443 NE 181ST ST
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4831
Practice Address - Country:US
Practice Address - Phone:425-424-2100
Practice Address - Fax:425-424-2100
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60016832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9659376-7110687Medicaid