Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD429105 | PA |
N | 208600000X | Surgeon | MD429105 | PA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD429105 | PA |
NPI | 1306019328 |
---|---|
Provider Name | Dr. Emily Ann Peterson |
First Address | State College, PA 16801-7986 |
Second Address | State College, PA 16801-7986 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2008 |
Last Update Date | 04/02/2020 |