Individual
SCOTT KERMIT PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
30681 OLSON ST APT 2, PEQUOT LAKES, MN 56472-3081
(218) 838-5363
Mailing address
30681 OLSON ST APT 2, PEQUOT LAKES, MN 56472-3081
(218) 838-5363
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2377139
MN
Other
Enumeration date
01/08/2020
Last updated
01/08/2020
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