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General NPI Number Information
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NPI Number | 1982630505
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Entity Type | Organization
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Legal Business Name | CENTER FOR NATURAL MEDICINE PA
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11800 SINGLETREE LN SUITE 310
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5328
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Country | US
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Telephone | 952-223-5669
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Fax |
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Provider Business Mailing Address
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Address Line | 902 E 2ND ST SUITE 327
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City | WINONA
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State | MN
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Zip | 55987-6354
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Country | US
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Telephone | 507-452-6640
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY WAYNE PETERSON
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Credential |
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Telephone | 507-452-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3067
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License Number State | MN
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