1942262332 NPI number — JEAN PETERS NP

Table of content: (NPI 1508936287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942262332 NPI number — JEAN PETERS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERS
Provider First Name:
JEAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERS
Provider Other First Name:
JEAN
Provider Other Middle Name:
HOURIGAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1942262332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 PARK AVE
Provider Second Line Business Mailing Address:
G1
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55415-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-873-6369
Provider Business Mailing Address Fax Number:
612-904-4341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 PARK AVE
Provider Second Line Business Practice Location Address:
G1
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55415-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-873-6369
Provider Business Practice Location Address Fax Number:
612-904-4341
Provider Enumeration Date:
04/03/2006

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: 363L00000X , with the licence number:  100802-7 , 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: 923911025973 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP27341 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 07-00748 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 125592 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 53M36PE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 176212500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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