Individual
KATHERINE A PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.P.
Contact information
Practice address
225 SMITH AVE N, SUITE 300, SAINT PAUL, MN 55102-2533
(651) 726-6200
(651) 241-0992
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0794675
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500015512
RAILROAD MEDICARE
MN
Enumeration date
07/20/2006
Last updated
10/09/2013
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