Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | R1013148 | MN |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R1013148 | MN |
N | 363LP0200X | Nurse Practitioner - Pediatrics | R1013148 | MN |
NPI | 1033177985 |
---|---|
Provider Name | Judy L Peterson |
First Address | Roseville, MN 55113 |
Second Address | St Paul, MN 55102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 08/07/2007 |