Healthcare Provider Details

I. General information

NPI: 1184643017
Provider Name (Legal Business Name): BARBARA JEAN PETERSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA JEAN KRATZ N.P.

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 SMITH AVE N PSYCHIATRY SERVICES SUITE 404
SAINT PAUL MN
55102-2387
US

IV. Provider business mailing address

347 NORTH SMITH AVENUE PSYCHIATRY SERVICES SUITE 404
ST. PAUL MN
55102
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6739
  • Fax: 651-220-6707
Mailing address:
  • Phone: 651-220-6739
  • Fax: 651-220-6707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR079088-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: