Individual provider · Type 1 NPI

Henry Petersen, PA-C

Medical Physician Assistant · Coeur D Alene, ID

NPI number 1891123543 Active

Practice location

700 W Ironwood Dr, Ste 320
Coeur D Alene, ID 83814-2656

Call (208) 625-5250 Map

Fax (208) 625-5251

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA-1146 (ID)

Medical Physician Assistant: Definition to come...

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About NPI 1891123543

Henry Petersen, PA-C's National Provider Identifier is 1891123543, issued on Oct 16, 2013. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Coeur D Alene, ID. The record was last updated on Jul 22, 2025.