Individual
MR. KEVIN WARREN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
300 S BRUCE ST, MARSHALL, MN 56258-1934
(507) 532-9661
Mailing address
3267 230TH AVE, GHENT, MN 56239-1104
(507) 828-4525
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R-16439-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026667100
—
MN
Enumeration date
02/13/2006
Last updated
09/10/2019
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