| NPI | 1235702192 |
|---|---|
| Former Name | JOLENE KAY PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 8492) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A171358) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 8492) | |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2022-10-18 |