Individual
SCOTT M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8990 SPRINGBROOK DR NW, STE 250, COON RAPIDS, MN 55433-5850
(763) 398-0099
(763) 398-0124
Mailing address
13330 GREENWICH CT, APPLE VALLEY, MN 55124-7620
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 121227-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
491525900
—
MN
01
—
507R4PE
BCBSMN
MN
Enumeration date
08/16/2005
Last updated
05/16/2008
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