Individual
KATIE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17521 93RD PL N, MAPLE GROVE, MN 55311-4437
(763) 577-7179
Mailing address
17521 93RD PL N, MAPLE GROVE, MN 55311-4437
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/10/2009
Last updated
09/10/2009
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