Petersen, Dana M
Petersen, Dana M is an individual health care provider with primary practice located at 3434 12Th Ave Ne , Olympia WA 98506. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Petersen, Dana M can be contacted via phone (360) 413-8470.Contact Information
Primary practice address
3434 12Th Ave Ne
Olympia WA 98506
Phone: (360) 413-8470
Fax: (360) 413-8490
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | MD00019243 | Washington |
Profile Details
| NPI number | 1912974155 |
|---|---|
| LBN Legal business name | Petersen, Dana M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 7th, 2006 |
| Last updated | Feb 3rd, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912974155 | NPPES |
| Washington | MEDICAID | 8422909 |
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