Individual
AMANDA VANCENE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
225 SMITH AVE N STE 501, SAINT PAUL, MN 55102-2545
(651) 726-6200
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-4400
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
1750728
MN
363LA2100X
Acute Care Nurse Practitioner
00000
MN
363LA2100X
Acute Care Nurse Practitioner
Primary
9286
MN
Other
Enumeration date
05/11/2022
Last updated
01/16/2023
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