Active NPI
Joseph John Petersen
- Licensed Practical Nurse
- Fergus Falls, MN
National Provider Identifier
1487808705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- L064304-3
- Practice address
- 106 North 4TH Avenue
Fergus Falls, MN 56537-1034 - Phone
- (218) 993-3778
- Fax
- (218) 993-3187
- NPI assigned
- Nov 13, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | L064304-3 | MN | Primary |
Addresses
Primary practice location
106 North 4TH Avenue
Fergus Falls, MN 56537-1034
Mailing address
1525 4TH Street N
Fargo, ND 58102
Phone (701) 306-8603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L064304-3 | MN | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CK Home Health Care Inc. | Past | Accepting new patients | |
| CK Home Health | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Assisted Living Facility
- Fergus Falls, MN
- NPI 1447553284
-
- Home Health Agency
- Fergus Falls, MN
- NPI 1568685683
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226534400000",
"number": "1487808705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1525 4TH STREET N",
"city": "FARGO",
"state": "ND",
"postal_code": "58102",
"telephone_number": "701-306-8603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 NORTH 4TH AVENUE",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "565371034",
"telephone_number": "218-993-3778",
"fax_number": "218-993-3187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JOSEPH",
"middle_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-11-13",
"last_updated": "2008-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MN",
"license": "L064304-3",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fergus Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.