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SCOTT KERMIT PETERSON RN
>> Registered Nurse >> Nursing Service ProvidersRegistrant NPI Number: 1801436787
Individual Registrant: SCOTT KERMIT PETERSON RN
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
30681 OLSON ST APT 2 PEQUOT LAKES, MN 56472-3081 US
Tel: 218-838-5363 Fax: --
Tel: 218-838-5363 Fax: --
Contact information for business:
30681 OLSON ST APT 2 PEQUOT LAKES, MN 56472-3081 US
Tel: 218-838-5363 Fax: --
Tel: 218-838-5363 Fax: --
Registration Information:
NPI: 1801436787
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 163W00000X | Nursing Service Providers Registered Nurse | MN | 2377139 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
