Individual
ETHAN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1406 6TH AVE N, SAINT CLOUD, MN 56303-1900
(320) 251-2700
Mailing address
3701 12TH ST N, SUITE 202, SAINT CLOUD, MN 56303-2255
(320) 258-3090
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 193342-2
MN
Other
Enumeration date
03/16/2010
Last updated
03/16/2010
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