License holder summary

AMANDA DENISE PETERSEN is a Board Of Medicine licensed to practice in Idaho. The address on file for AMANDA DENISE PETERSEN is 674 RANDOLPH AVE POCATELLO ID 83201. This licensed professional license is not current. The license was granted 09/24/2007 and expired on 07/31/2009.

Idaho

Division of Occupational and Professional Licenses

AMANDA DENISE PETERSEN
Board Of Medicine
License number
PAT-594
Date granted
09/24/2007
Date expires
07/31/2009
Class
Board Of Medicine
Status
Expired
Address
674 RANDOLPH AVE POCATELLO ID 83201
idaholicensing.com
ID 48348763
LAST UPDATED 2026-03-11 04:23:59 UTC

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