1467611657 NPI number — MS. LATRICIA ANN ALT-PETERS APRN, CNP

Table of content: MS. LATRICIA ANN ALT-PETERS APRN, CNP (NPI 1467611657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467611657 NPI number — MS. LATRICIA ANN ALT-PETERS APRN, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALT-PETERS
Provider First Name:
LATRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467611657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-632-6647
Provider Business Mailing Address Fax Number:
320-632-9525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13045 FALCON DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BAXTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56425-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-829-9307
Provider Business Practice Location Address Fax Number:
218-829-7649
Provider Enumeration Date:
06/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  CNP2129 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 834755700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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