Provider Demographics
NPI:1639191075
Name:PETERSON, JANET R (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:R
Last Name:PETERSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:204 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-9449
Mailing Address - Country:US
Mailing Address - Phone:715-483-3221
Mailing Address - Fax:715-483-0539
Practice Address - Street 1:204 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-9449
Practice Address - Country:US
Practice Address - Phone:715-483-3221
Practice Address - Fax:715-483-0539
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI66586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI66586OtherSTATE LICENCE
MN235E7PEOtherBLUE CROSS CLINIC
WIHP69858OtherHEALTHPARTNERS
MN093660100Medicaid
WI01 24269OtherMEDICA
WI36007300Medicaid
WINA9031047699OtherPREFERRED ONE