Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 67327 | MN |
Y | 111NI0900X | Internist | 67327 | MN |
NPI | 1003342130 |
---|---|
Provider Name | Abigail Ellen Peterson |
First Address | Bloomington, MN 55425-4516 |
Second Address | Saint Paul, MN 55101-2502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2017 |
Last Update Date | 20/05/2020 |