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Individual

KRISTIN LB PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

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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