Provider Demographics
NPI:1750385399
Name:PETERSON, CHRISTINE R (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:R
Last Name:PETERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 2ND ST NW STE 1
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-4469
Mailing Address - Country:US
Mailing Address - Phone:701-523-5555
Mailing Address - Fax:701-523-7107
Practice Address - Street 1:802 2ND ST NW
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623-4483
Practice Address - Country:US
Practice Address - Phone:701-523-5555
Practice Address - Fax:701-523-7107
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR24643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19699Medicaid
ND19699Medicaid
ND19868Medicare ID - Type Unspecified