Provider Demographics
NPI:1184643017
Name:PETERSON, BARBARA JEAN (NP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JEAN
Other - Last Name:KRATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:347 NORTH SMITH AVENUE
Mailing Address - Street 2:PSYCHIATRY SERVICES SUITE 404
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-220-6739
Mailing Address - Fax:651-220-6707
Practice Address - Street 1:347 SMITH AVE N
Practice Address - Street 2:PSYCHIATRY SERVICES SUITE 404
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2387
Practice Address - Country:US
Practice Address - Phone:651-220-6739
Practice Address - Fax:651-220-6707
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR079088-6363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1022196OtherPREFERRED ONE
HP22879OtherHEALTHPARTNERS
MT4303000Medicaid
12-01408OtherMEDICA CHOICE
12-01409OtherMEDICA PRIMARY
938505OtherARAZ/PPO
WI43941200Medicaid
12-01409OtherMEDICA PRIMARY