IndividualActive
Mariah Petersen, APP
NPI 1336938752 · Primary Care Nurse Practitioner · Coeur D Alene, ID
Provider details
- NPI number
- 1336938752
- Entity type
- Individual
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- APP
- Sex
- Female
- Sole proprietor
- No
- License
- 8771254 (ID)
Practice location
1919 Lincoln Way Ste 415
Coeur D Alene, ID 83814-2527
Phone: (208) 625-4595
Mailing address
6225 N Cornwall St
Coeur D Alene, ID 83815-5084
Registry dates
- Enumerated
- 2025-05-02
- Last updated
- 2025-05-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.