Mio Watanabe (NPI# 1730695412, PAC ID# 4789943036) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1730695412 |
| PAC ID by PECOS | 4789943036 |
| Professional Enrollment ID | I20190904000322 |
| Full Name | Mio Watanabe |
| Organization Legal Name | PETERSON MEDICAL CLINICS LLC |
| Address |
515 Bridge St Park Rapids MN 56470-1210 |
| Phone Number | 7017322509 |
| Gender | F |
| Graduation Year | 2017 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 9335412220 |
| Number of Group Practice Members | 14 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 021308 | NORTON SOUND REGIONAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 519 Anne St Nw, Suite A, Bemidji, MN 56601-4277 | 2184447013 | PETERSON MEDICAL CLINICS LLC |
| 515 Bridge St, Park Rapids, MN 56470-1210 | 7017322509 | PETERSON MEDICAL CLINICS LLC |
| Organization Legal Name | PETERSON MEDICAL CLINICS LLC |
| Physicians | 11 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Riki Hehe-amai Gifford-ferguson | Physician Assistant | Peterson Medical Clinics LLC | 316 Park Ave Se, Renville, MN 56284-2470 |
| David B Eberly | Physician Assistant | Peterson Medical Clinics LLC | 519 Anne St Nw, Suite A, Bemidji, MN 56601-4277 |
| Timothy A Peterson | Family Medicine | Peterson Medical Clinics LLC | 1202 23rd St S, Suite 3, Fargo, ND 58103-2951 |
| Jessica R Wichmann | Physician Assistant | Peterson Medical Clinics LLC | 519 Anne St Nw, Suite A, Bemidji, MN 56601-4277 |
| Megan Marie Weddingfeld | Nurse Practitioner | Peterson Medical Clinics LLC | 1202 23rd St S, Suite 3, Fargo, ND 58103-2951 |
| Thomas M Peterson | Psychiatry | Peterson Medical Clinics LLC | 1451 44th Ave S, Suite A, Grand Forks, ND 58201-3434 |
| Natasha Marie Krebs | Nurse Practitioner | Peterson Medical Clinics LLC | 1451 44th Ave S, Suite A, Grand Forks, ND 58201-3434 |
| Katie M Allen | Clinical Social Worker | Peterson Medical Clinics LLC | 1202 23rd St S, Suite 3, Fargo, ND 58103-2951 |
| Faith Murray-taylor | Nurse Practitioner | Peterson Medical Clinics LLC | 103 Fram St, Petersburg, AK 99833 |
| Kimber-lee Osowski | Clinical Social Worker | Peterson Medical Clinics LLC | 1451 44th Ave S, Suite A, Grand Forks, ND 58201-3434 |
| Street Address |
515 BRIDGE ST |
| City | PARK RAPIDS |
| State | MN |
| Zip | 56470-1210 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Laura Margaret Hansen | Clinical Social Worker | Lake Country Associates, Inc. | 515 Bridge St, Park Rapids, MN 56470-1210 |
| Jessica Rae Croatt Niemi | Clinical Social Worker | Lake Country Associates, Inc. | 515 Bridge St, Park Rapids, MN 56470-1210 |
| Jean I Greseth | Clinical Social Worker | Lake Country Associates, Inc. | 515 Bridge St, Park Rapids, MN 56470-1210 |
| Elissa J Anderson | Clinical Social Worker | Lake Country Associates, Inc. | 515 Bridge St, Park Rapids, MN 56470-1210 |
| Katherine Marie Meyers | Clinical Social Worker | Lake Country Associates, Inc. | 515 Bridge St, Park Rapids, MN 56470-1210 |
| Judith Ann Hoopman | Clinical Social Worker | Lake Country Associates, Inc. | 515 Bridge St, Park Rapids, MN 56470-1210 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Tracy J Smart | Chiropractic | 708 Bridge St, Park Rapids, MN 56470-1215 | |
| Dawn Renee Pappas | Clinical Social Worker | Groupworks LLC | 1003 Hollinger St, Park Rapids, MN 56470-1300 |
| Jessica T Burkhamer | Clinical Social Worker | Groupworks LLC | 1003 Hollinger St, Park Rapids, MN 56470-1300 |
| Deborah Jeanne Farrell | Clinical Social Worker | Groupworks LLC | 1003 Hollinger St, Park Rapids, MN 56470-1300 |
| Jennifer M Keller | Optometry | Park Rapids Walker Eye Clinic Od Pa | 100 Huntsinger Ave, Park Rapids, MN 56470-1326 |
| Murry D Westberg | Optometry | Park Rapids Walker Eye Clinic Od Pa | 100 Huntsinger Ave, Park Rapids, MN 56470-1326 |
| Lisa J Martin | Physical Therapy | Achieve Therapy LLC | 110 Pleasant Ave S, Park Rapids, MN 56470-1415 |
| Michael Perez | Optometry | Park Rapids Walker Eye Clinic Od Pa | 206 Pleasant Ave, Park Rapids, MN 56470-1417 |
| Michael E Erickson | Chiropractic | 400 Pleasant Ave S, Park Rapids, MN 56470-1428 | |
| William Lee Nyman | Diagnostic Radiology | St. Joseph's Area Health Services | 600 Pleasant Ave S, Park Rapids, MN 56470-1431 |
| Find all physicians in zip 56470 | |||
| City | PARK RAPIDS |
| Zip Code | 56470 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | PARK RAPIDS + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Mio Watanabe.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.