Active NPI
Jen Petersen, RPH
- Pharmacist
- Spirit Lake, IA
National Provider Identifier
1760258701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17899
- Practice address
- 2202 17TH St
Spirit Lake, IA 51360 - Phone
- (712) 336-4731
- Fax
- (800) 604-9151
- NPI assigned
- Nov 30, 2023
- Last updated
- Nov 30, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17899 | IA | Primary |
Addresses
Primary practice location
2202 17TH St
Spirit Lake, IA 51360
Mailing address
PO Box 303
Spirit Lake, IA 51360-0303
Phone (712) 336-4731
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17899 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Health Network | Past | Accepting new patients | |
| Sanford Health Network | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701302400000",
"number": "1760258701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 303",
"city": "SPIRIT LAKE",
"state": "IA",
"postal_code": "513600303",
"telephone_number": "712-336-4731",
"fax_number": "800-604-9151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2202 17TH ST",
"city": "SPIRIT LAKE",
"state": "IA",
"postal_code": "51360",
"telephone_number": "712-336-4731",
"fax_number": "800-604-9151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JEN",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-30",
"last_updated": "2023-11-30",
"certification_date": "2023-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "17899",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spirit Lake, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.