Petersen, Thea E
Petersen, Thea E is an individual health care provider with primary practice located at 1515 Village Dr Ste 220 , Cottage Grove OR 97424-9700. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Petersen, Thea E can be contacted via phone (541) 767-5200.Contact Information
Primary practice address
1515 Village Dr Ste 220
Cottage Grove OR 97424-9700
Phone: (541) 767-5200
Fax: (541) 767-5353
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD152665 | Oregon |
Profile Details
NPI number | 1083887087 |
---|---|
LBN Legal business name | Petersen, Thea E |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Apr 10th, 2008 |
Last updated | Apr 10th, 2023 - about last year |
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.
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