Provider Demographics
NPI:1487349874
Name:PETERSON, CHELSEA ANN (LAC, MACOM, RN)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LAC, MACOM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 FAIRVIEW AVE E STE 205
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3727
Mailing Address - Country:US
Mailing Address - Phone:253-987-6049
Mailing Address - Fax:
Practice Address - Street 1:1500 FAIRVIEW AVE E STE 205
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3727
Practice Address - Country:US
Practice Address - Phone:253-987-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61424626171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1639813330Medicaid