Provider Demographics
NPI:1902294358
Name:PETERSON, DANA ALEXANDRA (APRN)
Entity Type:Individual
Prefix:MISS
First Name:DANA
Middle Name:ALEXANDRA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 STINSON BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1747 BEAM AVE STE 100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1128
Practice Address - Country:US
Practice Address - Phone:651-232-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6699363LF0000X, 207T00000X
CT6046363L00000X, 363LF0000X
MARN2284104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner