Provider Demographics
NPI:1073584371
Name:PETERSON, JO A (WHCNP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:A
Last Name:PETERSON
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2502
Mailing Address - Country:US
Mailing Address - Phone:507-345-3287
Mailing Address - Fax:
Practice Address - Street 1:310 BELLE AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5287
Practice Address - Country:US
Practice Address - Phone:507-387-5581
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR090431-3363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN615S9PEOtherBCBS MN
111464OtherUCARE
1069924OtherAMERICA'S PPO (ARAZ)
HP21605OtherHEALTH PARTNERS
07-02759OtherMEDICA
1016958OtherPREFERRED ONE
20342OtherSIOUX VALLEY HEALTH PLAN
07-02759OtherMEDICA