Mandy Jo Peterson

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

1608485 Issued in MN

Practice address

15 Riverside Dr NE
Saint Cloud, MN 56304-0435

Phone

(320) 309-0679

NPI assigned

Feb 7, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mandy Jo Peterson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1003621137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1936 LINDA LN",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014968",
            "telephone_number": "320-309-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 RIVERSIDE DR NE",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563040435",
            "telephone_number": "320-309-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MANDY",
        "middle_name": "JO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-07",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "1608485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "PETERSON",
            "middle_name": "JO",
            "credential": "BSN, RN, PHN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Dennis L Peterson, M.D.
• Holly Christine Peterson, MD, SFHM
• Jennifer Peterson, LMFT
• Jon B Peterson, D.C.
• Kari Lee Peterson, DENTIST DDS
• Matthew J Peterson, LMFT
• Michelle Joan Peterson, RN CAGNP
• Nicole E Peterson, P.T.
• Paul Charles Peterson, MD
• Richard Allen Peterson, RN

• Registered Nurse in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.