Individual
KRISTIN LB PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
CHILDREN'S PRIMARY CLINIC - STPL, 347 NORTH SMITH AVENUE, ST. PAUL, MN 55102
(651) 220-6789
(651) 220-6807
Mailing address
CHILDREN'S HEALTH CARE, 2910 CENTRE POINTE DRIVE 35-121A, ROSEVILLE, MN 55113
(651) 855-2327
(651) 855-2310
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
42034
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400042100
—
MN
Enumeration date
08/04/2005
Last updated
09/04/2012
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