Individual
STACEY RAE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
899 E 12TH STREET APT 9453, DES MOINES, IA 50304-5030
(712) 541-1949
Mailing address
714 LINCOLN ST NE, LE MARS, IA 51031-3311
(712) 546-7871
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A171201
IA
Other
Enumeration date
09/14/2022
Last updated
12/08/2023
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