Individual
AYLA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1313 FAIRGROUNDS RD, TWO HARBORS, MN 55616-4600
(218) 969-6183
Mailing address
1313 FAIRGROUNDS RD, TWO HARBORS, MN 55616-4600
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
N000-024-230-200
MN
Other
Enumeration date
08/08/2024
Last updated
08/08/2024
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