Provider Demographics
NPI:1609860253
Name:PETERSON, MONICA L (DO)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:L
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:ROTSAERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:312 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2999
Mailing Address - Country:US
Mailing Address - Phone:319-352-4120
Mailing Address - Fax:
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2999
Practice Address - Country:US
Practice Address - Phone:319-352-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5213363Medicaid
IA1609860253Medicaid
IA719260189Medicare PIN
IAH41835Medicare UPIN
IA1609860253Medicaid