Provider Demographics
NPI:1437593266
Name:PETERS, LOIS ANN (BSN, RN, PHN, CLC)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:ANN
Last Name:PETERS
Suffix:
Gender:F
Credentials:BSN, RN, PHN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 23RD ST NE
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-6605
Mailing Address - Country:US
Mailing Address - Phone:320-522-4674
Mailing Address - Fax:320-231-7888
Practice Address - Street 1:2200 23RD ST NE
Practice Address - Street 2:SUITE 1080
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-6605
Practice Address - Country:US
Practice Address - Phone:320-522-4674
Practice Address - Fax:320-231-7888
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR190152-2163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health