Individual
EKATERINA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8611 W POINT DOUGLAS RD S, COTTAGE GROVE, MN 55016-4005
(651) 458-1884
Mailing address
8611 W POINT DOUGLAS RD S, COTTAGE GROVE, MN 55016-4005
(651) 458-1884
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11127
MN
363AM0700X
Medical Physician Assistant
11127
MN
Other
Enumeration date
08/23/2012
Last updated
03/12/2021
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