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General NPI Number Information
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NPI Number | 1518511492
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Entity Type | Individual
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Provider Name | NICOLE LINDSAY PETERSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 1603 35TH AVE SW
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City | MINOT
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State | ND
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Zip | 58701-8406
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Country | US
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Telephone | 701-838-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 511 19TH ST SE
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City | MINOT
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State | ND
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Zip | 58701-4153
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Country | US
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Telephone | 701-721-9460
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 202773
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License Number State | ND
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