Peterson, Carolyn G

Peterson, Carolyn G is an individual health care provider with primary practice located at 5779 E Mayo Blvd , Phoenix AZ 85054-4502. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Peterson, Carolyn G can be contacted via phone (480) 301-8000.

Contact Information

Primary practice address
5779 E Mayo Blvd Phoenix AZ 85054-4502
Phone: (480) 301-8000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 1874 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1874 Arizona

Profile Details

NPI number 1477535334
LBN Legal business name Peterson, Carolyn G
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 16th, 2005
Last updated Feb 11th, 2021 - about 5 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 1477535334 NPPES
Arizona MEDICAID 344458
Arizona Other 240004028
Arizona Other 86080015085259A199

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