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General NPI Number Information
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NPI Number | 1922536267
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Entity Type | Individual
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Provider Name | MCKENZIE REILE PETERSON DNP, APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 705 E MAIN AVE
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City | BISMARCK
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State | ND
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Zip | 58501-4525
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Country | US
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Telephone | 701-502-4669
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Fax | 833-608-1015
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Provider Business Mailing Address
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Address Line | PO BOX 7433
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City | BISMARCK
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State | ND
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Zip | 58507-7433
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Country | US
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Telephone | 701-226-7586
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Fax | 833-608-1015
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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 | R36156
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License Number State | ND
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