Individual
DR. CHRISTINE RENNAE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1213 GILMORE AVE, WINONA, MN 55987-2474
(507) 454-1792
(507) 454-1793
Mailing address
1363 GRANDVIEW CT, MINNESOTA CITY, MN 55959-1209
(507) 494-0042
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2885 - 035
WI
152W00000X
Optometrist
Primary
MN 2563
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202971
MEDICA
MN
01
—
52P81PE
BCBS
MN
Enumeration date
09/17/2006
Last updated
07/09/2007
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