Individual
TYLER M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1901 CONNECTICUT AVE S, SARTELL, MN 56377-2554
(320) 259-4100
(320) 257-5523
Mailing address
1901 CONNECTICUT AVE S, SARTELL, MN 56377-2554
(320) 259-4100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14942
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/28/2023
Last updated
07/26/2024
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