Individual
AMANDA MICHELLE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1601 SAINT FRANCIS AVE STE 100, SHAKOPEE, MN 55379-3384
(952) 428-3535
(952) 428-3599
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12245
MN
363AS0400X
Surgical Physician Assistant
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Other
Enumeration date
08/11/2016
Last updated
01/16/2023
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