Provider Demographics
NPI:1548214273
Name:PETERSEN, BONNIE J (CNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6738
Mailing Address - Country:US
Mailing Address - Phone:605-366-7137
Mailing Address - Fax:605-332-1617
Practice Address - Street 1:625 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0602
Practice Address - Country:US
Practice Address - Phone:605-332-2240
Practice Address - Fax:605-332-1617
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS100758Medicare PIN
SDP00360527Medicare PIN