Individual
JO A PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
WHCNP
Contact information
Practice address
310 BELLE AVE, MANKATO, MN 56001-5287
(507) 387-5581
Mailing address
617 BAKER AVE, MANKATO, MN 56001-2502
(507) 345-3287
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R090431-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07-02759
MEDICA
—
01
—
1016958
PREFERRED ONE
—
01
—
1069924
AMERICA'S PPO (ARAZ)
—
01
—
111464
UCARE
—
01
—
20342
SIOUX VALLEY HEALTH PLAN
—
01
—
615S9PE
BCBS MN
MN
01
—
HP21605
HEALTH PARTNERS
—
Enumeration date
01/27/2006
Last updated
07/08/2007
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