Healthcare Provider Details

I. General information

NPI: 1558420380
Provider Name (Legal Business Name): LINDA K PETERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 LAKEVIEW DR
YANKTON SD
57078-5111
US

IV. Provider business mailing address

2709 LAKEVIEW DR
YANKTON SD
57078-5111
US

V. Phone/Fax

Practice location:
  • Phone: 605-260-6580
  • Fax:
Mailing address:
  • Phone: 605-260-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR015837
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: