Organization
SHIFTING FOCUS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELYSIA PETERSON PMHNP (PSYCHIATRIC NURSE PRACTITIONER)
(320) 385-1010
Entity
Organization
Contact information
Practice address
408 GREAT OAK DR # 408A, WAITE PARK, MN 56387-2504
(320) 385-1010
(320) 295-7906
Mailing address
408 GREAT OAK DR # 408A, WAITE PARK, MN 56387-2504
(320) 385-1010
(320) 295-7906
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/09/2019
Last updated
07/29/2019
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