Provider Demographics
NPI:1962525626
Name:VETSCH-PETERSON, MARGERY ANN (RN)
Entity type:Individual
Prefix:
First Name:MARGERY
Middle Name:ANN
Last Name:VETSCH-PETERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28347 112TH ST
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-4307
Mailing Address - Country:US
Mailing Address - Phone:763-389-5412
Mailing Address - Fax:763-389-5412
Practice Address - Street 1:28347 112TH ST
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-4307
Practice Address - Country:US
Practice Address - Phone:763-389-5412
Practice Address - Fax:763-389-5412
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR127273-0163W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator