Provider Demographics
NPI:1033497896
Name:PETERSEN, LINDSAY K (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:K
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3433
Mailing Address - Country:US
Mailing Address - Phone:563-262-4111
Mailing Address - Fax:563-264-9175
Practice Address - Street 1:201 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-4006
Practice Address - Country:US
Practice Address - Phone:563-299-1380
Practice Address - Fax:563-281-6495
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-119979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2621010Medicare PIN