Healthcare Provider Details

I. General information

NPI: 1346164134
Provider Name (Legal Business Name): STEVEN PETERSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 LOUISIANA AVE S
SAINT LOUIS PARK MN
55426-4375
US

IV. Provider business mailing address

5641 LOGAN AVE S
MINNEAPOLIS MN
55419-1511
US

V. Phone/Fax

Practice location:
  • Phone: 612-341-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number14577
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: