Basic Information
| Provider Information | |||||||||
| NPI: | 1518575174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37902 127TH ST | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574018377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054600434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 LAKE TRAVERSE DR | ||||||||
| Address2: | |||||||||
| City: | SISSETON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572627046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056987606 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2020 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CP001793 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.