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NPI Code Detail

MEDICARE: MELANIE PETERSON RN

MEDICARE: MELANIE PETERSON 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
1163WP2201XAmbulatory Care Registered NurseR039375SD

General Provider Information

NPI Number : 1790596245
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELANIE PETERSON RN
Provider Business Mailing Address
First Line : 6309 S MOGEN AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57108-5707
Country : US
Telephone Number : 605-336-3230
Fax Number : 612-725-1289
Provider Business Practice Location Address
First Line : 2501 W 22ND ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57105-1305
Country : US
Telephone Number : 605-336-3230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2025
Last Update Date : 03/31/2026

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