Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Glenn Adam Peterson, PA-C

Individual provider Physician Assistant · NPI 1972031698

Glenn Adam Peterson, PA-C is a Physician Assistant in Poulsbo, Washington. Works from 4 locations. Licensed in Illinois and Washington.

Licensed in
IL, WA
In the registry since
2017
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

19835 10th Ave NE Ste B
Poulsbo, WA 98370-7451
Phone: (360) 779-7011
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 412 S. Jackson St., Belleville, IL 62220 — (618) 550-9746
  • 4500 Memorial Dr, Belleville, IL 62226-5360 — (618) 233-7750
  • 939 Caroline St, Port Angeles, WA 98362-3997 — (360) 417-7000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA61047355 (WA)
Physician Assistant Taxonomy 363A00000X · Licence 085006213 (IL)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1972031698
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 25, 2017
Last updated in NPPESJuly 21, 2022
Certification dateMay 21, 2021

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