Individual
LEAH PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7455 VILLAGE DR, LINO LAKES, MN 55014-1181
(651) 717-3400
Mailing address
1002 LANTERN LN, LINO LAKES, MN 55014-1335
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10594
MN
Other
Enumeration date
05/21/2009
Last updated
06/16/2010
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