Individual
HOLLY CHRISTINE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, SFHM
Contact information
Practice address
1200 SIXTH AVE N, CENTRA CARE CLINIC, ST CLOUD, MN 56303-2735
(320) 251-2700
(320) 240-2118
Mailing address
1200 SIXTH AVE N, CENTRA CARE CLINIC, ST CLOUD, MN 56303-2735
(320) 251-2700
(320) 240-2118
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
44593
MN
208M00000X
Hospitalist Physician
Primary
44593
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0404508
MEDICA HEALTH PLANS
—
01
—
1030668
PREFERRED ONE
—
01
—
110008471
MEDICARE
—
01
—
142118
U-CARE
—
01
—
2116659
FIRST HEALTH PLAN
—
01
—
314780100
MEDICAL ASSISTANCE (MA)
—
05
—
314780100
—
MN
01
—
59G88PE
BLUE CROSS BLUE SHIELD
—
01
—
951364
ARAZ GROUP/AMERICA'S PPO
—
01
—
HP35318
HEALTH PARTNERS
—
Enumeration date
10/12/2005
Last updated
10/30/2015
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