Provider Demographics
NPI:1215303573
Name:PETERSON, ASHLEY ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:ANN
Other - Last Name:WILMOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4464 RALSTON DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1519
Mailing Address - Country:US
Mailing Address - Phone:218-722-8634
Mailing Address - Fax:
Practice Address - Street 1:4464 RALSTON DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1519
Practice Address - Country:US
Practice Address - Phone:218-722-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 1650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily