MR. Wiley D Petersen, PA-C

NPI #1568920080 in Chubbuck, Idaho

Provider Information

NPI Number
1568920080
Entity Type
Individual
Name
MR. Wiley D Petersen, PA-C
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Physician Assistant
Credential
PA-C
Enumeration Date
Mar 4, 2019
Last Updated
May 17, 2024

Practice Location

Address
134 W CHUBBUCK RD
State
Idaho
ZIP Code
83202-2338
Phone
(208) 417-0102

Specialties & Taxonomy Codes

Specialty
Physician Assistant

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