Individual
JODI L PETERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
333 SMITH AVE N, SAINT PAUL, MN 55102-2344
(651) 735-0501
(651) 735-1870
Mailing address
8681 EAGLE POINT BLVD, LAKE ELMO, MN 55042-8628
(651) 209-8071
(651) 209-8077
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R1459728
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050428000
—
MN
Enumeration date
01/04/2007
Last updated
03/14/2012
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