BREANNA PETERSON (NPI# 1013399112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013399112 |
| Entity Type | Individual |
| Full Name | BREANNA PETERSON |
| Credential | D.O. |
| Practice Address |
911 Northland Dr Princeton MN 55371 |
| Mailing Address |
400 Stinson Blvd Minneapolis MN 55413-2614 |
| Practice Telephone | 7633891313 |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2019-09-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 66330 | MN | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 66330 | MN | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 2015018606 | MO | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2345 Dougherty Ferry Rd, Saint Louis, MO 631223313 | 3149669491 |
| Street Address |
911 NORTHLAND DR |
| City | PRINCETON |
| State | MN |
| Zip Code | 55371 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922085299 | Fairview Health Services | Pathology | 911 Northland Dr, Princeton, MN 55371-2172 | 2005-12-28 |
| 1912515388 | Fairview Express Care | General Practice | 911 Northland Dr, Princeton, MN 55371-2172 | 2020-07-21 |
| 1780226142 | Paul Moench | Physical Therapist | 911 Northland Dr, Princeton, MN 55371-2172 | 2019-10-17 |
| 1730652512 | Nicole Burrington | Speech-Language Pathologist | 911 Northland Dr, Princeton, MN 55371-2172 | 2019-01-04 |
| 1972015550 | Morgan Taubel | Dietitian, Registered | 911 Northland Dr, Princeton, MN 55371-2172 | 2017-11-03 |
| 1457871956 | Sara Jesse Gleason | Physical Therapist | 911 Northland Dr, Princeton, MN 55371-2172 | 2017-06-26 |
| 1952779266 | Fairview Health Services | Family Medicine | 911 Northland Dr, Princeton, MN 55371-2172 | 2015-09-03 |
| 1376929547 | Dominique Meyer | Nurse Practitioner | 911 Northland Dr, Princeton, MN 55371-2172 | 2015-08-10 |
| 1841673647 | Fairview Health Services | Family Medicine | 911 Northland Dr, Princeton, MN 55371-2172 | 2015-06-30 |
| 1861879330 | Fairview Health Services | Prosthetic/Orthotic Supplier | 911 Northland Dr, L001, Princeton, MN 55371-2172 | 2015-05-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053962530 | Monica Gail Broten | Technician | 30840 Tiger Street Nw, Princeton, MN 55371 | 2019-09-25 |
| 1215349584 | Stephen Destefano | Pharmacist | 31419 131st Street, Princeton, MN 55371 | 2014-05-21 |
| 1164798948 | Andrew Sudbeck | Counselor | 101 18th Avenue North, Princeton, MN 55371 | 2012-03-27 |
| 1073804803 | Sterling Pointe Senior Living LLC | Assisted Living Facility | 1250 Northland Drive, Princeton, MN 55371 | 2011-04-27 |
| 1568752533 | Rum River Health Services, Inc. | Substance Abuse Rehabilitation Facility | 3079 90th Avenue, Princeton, MN 55371 | 2011-04-12 |
| 1780989038 | Dr. Kynan Westermeyer, Dds, Pllc | Clinic/Center | 404 1st St. N, Princeton, MN 55371 | 2011-01-18 |
| 1275788085 | Cody James Leff | Pharmacist | 1100 11th Avenue South, Princeton, MN 55371 | 2008-11-20 |
| 1164679213 | Rum River Health Services, Inc | Substance Abuse Rehabilitation Facility | 1101 N 5th St, Princeton, MN 55371 | 2008-08-20 |
| 1801059639 | Rum River Health Services, Inc | Substance Abuse Rehabilitation Facility | 1506 1st Street, Princeton, MN 55371 | 2008-07-02 |
| 1497940928 | James Michael Mandt | Pharmacist | 911 Northland Drive, Fairview Northland Medical Center, Princeton, MN 55371 | 2007-09-07 |
| Find all providers in zip 55371 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790170835 | Chad Williams | Emergency Medicine | 177 Highpoint Ln, Princeton, WV 24739-6454 | 2015-04-06 |
| 1326351461 | Medexpress Urgent Care, Inc - West Virginia | Emergency Medicine | 277 Greasy Ridge Road, Princeton, WV 24740-6900 | 2010-07-19 |
| 1447372867 | Mark Alexander Spitzer | Emergency Medicine | 2767 Clover Dew Dairy Rd, Princeton, WV 24740-7548 | 2007-04-05 |
| 1578698163 | Charles John Mchugh | Emergency Medicine | 4 Charlton St, Princeton, NJ 08540-5232 | 2007-02-22 |
| 1366503088 | Dennis P Price | Emergency Medicine | 59 Coppervail Ct, Princeton, NJ 08540-7714 | 2006-12-13 |
| 1922114677 | Paul H Bonucci | Emergency Medicine | 2128 N Main St, Princeton, IL 61356-9728 | 2006-08-22 |
| 1316971807 | J. Eric Dario Castro | Emergency Medicine | 530 Park Ave East, Dept of Emergency Medicine, Princeton, IL 61356 | 2006-07-10 |
| 1952333494 | Nara C Shin | Emergency Medicine | Washington Road, Princeton, NJ 08544-5002 | 2006-07-07 |
| 1750327342 | James P Morgan | Emergency Medicine | 277 Greasy Ridge Rd, Princeton, WV 24739-6900 | 2006-06-21 |
| 1306887674 | Gregg E Davis | Emergency Medicine | 204 Park Ave E, Princeton, IL 61356-2114 | 2006-06-09 |
| Find all providers in PRINCETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.