Individual
LAUREN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
409 DUNLAP ST N, SAINT PAUL, MN 55104-4201
(651) 290-9200
Mailing address
1021 ROMA AVE, ROSEVILLE, MN 55113-6527
(775) 450-3000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11788
MN
Other
Enumeration date
02/24/2015
Last updated
05/05/2016
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