| Doctor Name: | JUDY L PETERSON |
| NPI Number: | 1033177985 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNNP CPNP |
| License Number: | R1013148 |
| Business Practice Address: | 347 North Smith Ave Childrens Specialty Clinic Nicu St Paul, MN - 55102 |
| Business Phone Number: | 6512206210 |
| Business Fax Number: | 6512207777 |
| Mailing Address: | 2910 Centre Pointe Dr, 35-121a Childrens Health Care ROSEVILLE |
| State: | MN |
| Postal Code: | 55113 |
| Phone Number: | 6518552327 |
| Fax Number: | 6518552310 |
| NPI Enumeration Date: | 05/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LN0000X |
| License Number: | R1013148 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Neonatal |
| Taxonomy Definition: | |