Petersen, Amanda D

Petersen, Amanda D is an individual health care provider with primary practice located at 4804 W Clearwater Ave Kadlec Clinic Urgent Care, Kennewick WA 99336. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Petersen, Amanda D can be contacted via phone (509) 942-2355.

Contact Information

Primary practice address
4804 W Clearwater Ave Kadlec Clinic Urgent Care Kennewick WA 99336
Phone: (509) 942-2355
Fax: (509) 222-2355
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PENDING Washington
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA60113833 Washington

Profile Details

NPI number 1528391372
LBN Legal business name Petersen, Amanda D
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 11th, 2009
Last updated Jan 22nd, 2014 - about 12 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 1528391372 NPPES
Washington MEDICAID 1528391372

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