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1417821414 NPI number — EMILY JANE PETERSON FNP

NPI Number: 1417821414
Health Care Provider/Practitioner: EMILY JANE PETERSON FNP

Information about “1417821414” NPI (EMILY JANE PETERSON FNP) exists in 1417821414 in HTML format HTML  |  1417821414 in plain Text format TXT  |  1417821414 in PDF (Portable Document Format) PDF  |  1417821414 in an XML format XML  formats.

NPI Number : 1417821414 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417821414",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETERSON",
    "FirstName": "EMILY",
    "MiddleName": "JANE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ISRAELSON",
    "OtherFirstName": "EMILY",
    "OtherMiddleName": "JANE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "8140 ZENITH AVE S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MINNEAPOLIS",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55431-1055",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "218-296-0714",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9825 HOSPITAL DR STE 300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MAPLE GROVE",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55369-4768",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "763-587-7999",
    "PracticeLocationAddressFaxNumber": "763-494-7501",
    "EnumerationDate": "10/02/2025",
    "LastUpdateDate": "10/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "2484239",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "13416",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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