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:
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Health care specialties

SpecialtyCodeLicense #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 3 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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