Provider Demographics
NPI:1356450860
Name:PETERSON, DEBRA J (RN, CFNP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:J
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN, CFNP
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Mailing Address - Street 1:2271 FOREST SHORES RD
Mailing Address - Street 2:
Mailing Address - City:OGILVIE
Mailing Address - State:MN
Mailing Address - Zip Code:56358-3927
Mailing Address - Country:US
Mailing Address - Phone:952-546-6866
Mailing Address - Fax:952-512-0038
Practice Address - Street 1:12450 WAYZATA BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1978
Practice Address - Country:US
Practice Address - Phone:952-546-6866
Practice Address - Fax:952-512-0038
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS76969Medicare UPIN