Provider Demographics
NPI:1215059753
Name:PETERSON, GAYLE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:MARIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:18160 SENCILLO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1325
Mailing Address - Country:US
Mailing Address - Phone:858-451-3787
Mailing Address - Fax:
Practice Address - Street 1:8695 SPECTRUM CENTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1489
Practice Address - Country:US
Practice Address - Phone:858-499-5259
Practice Address - Fax:858-499-5317
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483597363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health