Petersen, Winston N

Petersen, Winston N is an individual health care provider with primary practice located at 800 Falls Ave Suite 2, Twin Falls ID 83301-3366. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Petersen, Winston N can be contacted via phone (208) 734-6091.

Contact Information

Primary practice address
800 Falls Ave Suite 2 Twin Falls ID 83301-3366
Phone: (208) 734-6091
Fax: (208) 734-4654
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 262207-1206 Utah

Profile Details

NPI number 1194714717
LBN Legal business name Petersen, Winston N
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 17th, 2005
Last updated Apr 29th, 2016 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194714717 NPPES
Idaho MEDICAID 807969000
Idaho Other PAG40
Idaho Other PAG41
Idaho Other 000010165444
Idaho Other 000010165445
Idaho Other 000010165446
Idaho MEDICAID 807969002
Idaho Other PAG39
Idaho MEDICAID 807969001

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