Individual
SUSAN A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1406 6TH AVE N, SAINT CLOUD, MN 56303-1900
(320) 251-2700
Mailing address
3701 12TH ST N, STE 202, SAINT CLOUD, MN 56303-2255
(320) 258-3090
(320) 258-3095
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 134635-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078417000
—
MN
Enumeration date
09/10/2007
Last updated
04/28/2008
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