MEDICARE: MISS DANA ALEXANDRA PETERSON APRN

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	363LF0000X	Family Nurse Practitioner	6699	MN
2	207T00000X	Neurological Surgery Physician	6699	MN
3	363L00000X	Nurse Practitioner	6046	CT
4	363LF0000X	Family Nurse Practitioner	RN2284104	MA
5	363LF0000X	Family Nurse Practitioner	6046	CT

General Provider Information

NPI Number	:	1902294358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DANA ALEXANDRA PETERSON APRN

Provider Business Mailing Address
First Line	:	400 STINSON BLVD FL 2
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1747 BEAM AVE STE 100
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1128
Country	:	US
Telephone Number	:	651-232-3900
Fax Number	:

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

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	06/01/2022

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