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NPI Code Detail

MEDICARE: ERIC JULIAN PETERSON CRNA,MSN

MEDICARE: ERIC JULIAN PETERSON CRNA,MSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist53163, R131880-1MN

General Provider Information

NPI Number : 1265436059
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC JULIAN PETERSON CRNA,MSN
Provider Business Mailing Address
First Line : 1011 15TH AVE NW
Second Line :
City : WILLMAR
State : MN
Zip : 56201-2138
Country : US
Telephone Number : 320-214-1222
Fax Number :
Provider Business Practice Location Address
First Line : 301 BECKER AVE SW
Second Line :
City : WILLMAR
State : MN
Zip : 56201-3302
Country : US
Telephone Number : 320-231-4120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 03/29/2023

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