Provider Demographics
NPI:1578681995
Name:PETERSON, HEIDI J (NP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:PETERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:J
Other - Last Name:WESTPHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1600 2ND AVE SW STE 19
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3459
Mailing Address - Country:US
Mailing Address - Phone:701-852-4600
Mailing Address - Fax:701-852-4644
Practice Address - Street 1:1600 2ND AVE SW STE 19
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3459
Practice Address - Country:US
Practice Address - Phone:701-852-4600
Practice Address - Fax:701-852-4644
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR28403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNPENDINGMedicaid
PENDINGMedicare UPIN
MNPENDINGMedicare ID - Type Unspecified