Provider Demographics
NPI:1386276053
Name:PETERS, TAYLOR (RDN)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 COUNTY HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-2181
Mailing Address - Country:US
Mailing Address - Phone:320-305-2286
Mailing Address - Fax:
Practice Address - Street 1:1815 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1653
Practice Address - Country:US
Practice Address - Phone:320-314-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered