Individual
MRS. KELLY RAE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
9803 VAGABOND LN N, MAPLE GROVE, MN 55311-1364
(612) 242-1341
Mailing address
9803 VAGABOND LN N, MAPLE GROVE, MN 55311-1364
(612) 242-1341
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
88989
MN
Other
Enumeration date
10/13/2011
Last updated
01/26/2012
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