Individual
KATIE MARIE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
3931 LOUISIANA AVE S, SUITE E202, SAINT LOUIS PARK, MN 55426-5000
(952) 993-9184
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3298
MN
363LG0600X
Gerontology Nurse Practitioner
AG0614152
MN
Other
Enumeration date
08/18/2014
Last updated
03/10/2021
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