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General NPI Number Information
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NPI Number | 1316379597
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Entity Type | Individual
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Provider Name | JENNIFER LEE PETERSON APRN CNP
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Gender | Female
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 614 MICHIGAN AVE W
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City | WALKER
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State | MN
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Zip | 56484-2276
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Country | US
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Telephone | 218-547-7700
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Fax | 320-219-7149
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Provider Business Mailing Address
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Address Line | PO BOX 5074
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City | SIOUX FALLS
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State | SD
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Zip | 57117-5074
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Country | US
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Telephone | 605-328-9419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R1408449
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R 140844-9
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP0445
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License Number State | MN
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