Provider Demographics
NPI:1649363433
Name:PETERS, ANNA MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:PETERS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 KING ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6223
Mailing Address - Country:US
Mailing Address - Phone:360-676-1696
Mailing Address - Fax:360-676-6636
Practice Address - Street 1:1345 KING ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6223
Practice Address - Country:US
Practice Address - Phone:360-676-1696
Practice Address - Fax:360-676-6636
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 14687363LF0000X
OR201150021NP363LF0000X
WAAP60430886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR159302Medicare PIN