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Contact Information

MARIAH PETERSEN, APP
1919 LINCOLN WAY STE 415
COEUR D'ALENE, ID83814-2527
 Phone: 208-625-4595
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Primary Care

363LP2300X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for MARIAH PETERSEN · (Female)

NPI # 1336938752
Status Active
Credentials APP
Entity Individual
Enumeration date 05/02/2025
Last updated 05/02/2025 - More than a year ago
Sole proprietor 1 No
Identifiers
  • ID License # 8771254
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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