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General NPI Number Information
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NPI Number | 1417821414
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Entity Type | Individual
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Provider Name | EMILY JANE PETERSON FNP
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Gender | Female
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 9825 HOSPITAL DR STE 300
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4768
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Country | US
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Telephone | 763-587-7999
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Fax | 763-494-7501
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Provider Business Mailing Address
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Address Line | 8140 ZENITH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55431-1055
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Country | US
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Telephone | 218-296-0714
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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 | 2484239
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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 | 13416
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License Number State | MN
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