Gina Renee Peterson, PA
Physician Assistant in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1497005474
StatusActive
Last updated in NPPESOct 30, 2015
Details
- NPI
- 1497005474
- Entity type
- Individual (NPI-1)
- Name
- Gina Renee Peterson
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 17, 2012
- Last updated
- Oct 30, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 5601006479 | MI | Yes |
Other names
- Gina Renee Blodgett (Former Name)
Practice location
330 E Beltline Ave NeSuite 100
Grand Rapids, MI 49506-1267
Phone 616-752-6235 · Fax 616-328-8176
Mailing address
330 E Beltline Ave NeSuite 100
Grand Rapids, MI 49506-1267
Phone 616-752-6235 · Fax 616-328-8176
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