Provider Demographics
NPI:1568282168
Name:PETERSEN, LINDSAY MASHAE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:MASHAE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2096 E EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5368
Mailing Address - Country:US
Mailing Address - Phone:435-730-1957
Mailing Address - Fax:
Practice Address - Street 1:519 W STATE RD STE 103
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2158
Practice Address - Country:US
Practice Address - Phone:801-477-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12087835-4405363LP0808X
UT12087835-8900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health