| Doctor Name: | LEAH PETERSON |
| NPI Number: | 1154556942 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 10594 |
| Business Practice Address: | 7455 Village Dr Lino Lakes, MN - 550141181 |
| Business Phone Number: | 6517173400 |
| Business Fax Number: | |
| Mailing Address: | 1002 Lantern Ln, LINO LAKES |
| State: | MN |
| Postal Code: | 550141335 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/21/2009 |
| NPI Last Update Date: | 06/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 10594 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |