Individual
DR. RANDY WAYNE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, CNP
Contact information
Practice address
800 E 28TH ST # W4300, MINNEAPOLIS, MN 55407-3723
(612) 863-3110
(612) 863-8927
Mailing address
PO BOX 43, MINNEAPOLIS, MN 55440-0043
(612) 262-1166
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R214182-8
MN
363L00000X
Nurse Practitioner
Primary
7781
MN
Other
Enumeration date
05/30/2019
Last updated
02/09/2024
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