MEDICARE: MS. SHELLEY MARIE PETERS RN

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
1	163W00000X	Registered Nurse	2534268	MN

General Provider Information

NPI Number	:	1770376220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY MARIE PETERS RN

Provider Business Mailing Address
First Line	:	225 S 6TH ST STE 4000
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-4625
Country	:	US
Telephone Number	:	612-361-8247
Fax Number	:	612-314-4778

Provider Business Practice Location Address
First Line	:	225 S 6TH ST STE 4000
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-4625
Country	:	US
Telephone Number	:	612-361-8247
Fax Number	:	612-314-4778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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