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Individual

MS. JERALYN MARLO PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RDH

Contact information

Practice address
40520 COUNTY HIGHWAY 34, OGEMA, MN 56569-9612
(218) 983-4300
(218) 983-6284
Mailing address
40520 COUNTY HIGHWAY 34, OGEMA, MN 56569-9612
(218) 983-4300
(218) 983-6284

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H6077
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
H6077
MINNESOTA HYGIENIST LICENSE
MN
Enumeration date
10/18/2017
Last updated
10/18/2017
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