Provider Demographics
NPI:1942262332
Name:PETERS, JEAN (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:HOURIGAN
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:G1
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-6369
Mailing Address - Fax:612-904-4341
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:G1
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-6369
Practice Address - Fax:612-904-4341
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100802-7363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN923911025973OtherPREFERRED ONE
MNHP27341OtherHEALTH PARTNERS
MN07-00748OtherMEDICA
MN125592OtherUCARE
MN53M36PEOtherBCBS
MN176212500Medicaid