Genevieve Petricka

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2892 Issued in MN

Practice address

110105 Pioneer TRL
Suite 201
Chaska, MN 55318-2680

Phone

(952) 512-2470

NPI assigned

Mar 16, 2017

Last updated

Mar 16, 2017By the provider in NPPES

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

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": "1489622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489622400000",
    "number": "1457892945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15360 18TH AVE N",
            "address_2": "APT 1009",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554472429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110105 PIONEER TRL",
            "address_2": "SUITE 201",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553182680",
            "telephone_number": "952-512-2470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRICKA",
        "first_name": "GENEVIEVE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-16",
        "last_updated": "2017-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "2892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Peterson
• Nicole Peterson, DNP, APRN, FNP-C
• Rachael Peterson, MS LPC LADC CCTP
• Richard Todd Peterson, M.D.
• Tabitha Peterson, PHARM.D.
• Jennifer R Petron, MA
• Joshua James Pfister, OD
• Claire Pieper, B.A., M.S.W.
• Ruth Ann Plante, MA, LPCC
• Alexandra Pokorny

• Athletic Trainer in Chaska, MN
• Providers in Chaska, MN by specialty
• Athletic Trainer in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; 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.