Iris Havlina Donovan Petersen, MD

Pediatrics Physician · Olympia, WA

Individual Active NPI

NPI number 1659868560

Practice location

3434 12TH Ave NE
Olympia, WA 98506-5175
Phone
(360) 413-8470

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NPI record

NPI
1659868560
Entity type
Individual (Type 1)
Enumeration date
April 16, 2018
Last updated
August 8, 2021
Certified
August 8, 2021
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Pediatrics Physician Primary 208000000X MD61140296 WA
Pediatrics Physician 208000000X 11405455-1205 UT

About Dr. Petersen

Iris Havlina Donovan Petersen, MD is a healthcare provider registered in the NPI registry with the primary taxonomy Pediatrics Physician (code 208000000X). The practice location is 3434 12TH Ave NE, Olympia, WA 98506-5175. The NPI number 1659868560 was assigned on April 16, 2018 and the record was last updated on August 8, 2021.

Dr. Petersen lists 2 licenses in the registry: #MD61140296 (WA) for Pediatrics Physician; #11405455-1205 (UT) for Pediatrics Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Iris Havlina Donovan Petersen, MD?

The NPI number is 1659868560.

What is the phone number of Dr. Petersen?

The phone number listed for the practice location is (360) 413-8470.

Where is Dr. Petersen located?

3434 12TH Ave NE, Olympia, WA 98506-5175.

What is the taxonomy code for Dr. Petersen?

The primary taxonomy code is 208000000X – Pediatrics Physician; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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