Provider Demographics
NPI:1518622737
Name:MOTONDI, PETER (RN)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MOTONDI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 SWITCHGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-8533
Mailing Address - Country:US
Mailing Address - Phone:612-850-2215
Mailing Address - Fax:
Practice Address - Street 1:13820 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4519
Practice Address - Country:US
Practice Address - Phone:612-850-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2471327163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse