Individual
KENDRA PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2211 RIVERSIDE AVENUE SOUTH, CAMPUS BOX 149, MINNEAPOLIS, MN 55454
(612) 330-1399
(612) 330-1757
Mailing address
2211 RIVERSIDE AVENUE SOUTH, CAMPUS BOX 149, MINNEAPOLIS, MN 55454
(612) 330-1399
(612) 330-1757
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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