Individual
MS. PENNY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
525 N FOSTER ST, MITCHELL, SD 57301-2966
(605) 995-2000
Mailing address
525 N FOSTER ST, MITCHELL, SD 57301-2966
(605) 995-2000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
000437
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6831840
—
SD
01
—
S1639
MEDICARE PTAN
SD
Enumeration date
01/18/2006
Last updated
02/26/2010
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