Shane Peterson

NPI #1972181246 in Mora, Minnesota

Provider Information

NPI Number: 1972181246
Entity Type: Individual
Name: Shane Peterson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Driver
Enumeration Date: Mar 30, 2021
Last Updated: Mar 30, 2021

Practice Location

Address: 325 WATKINS ST
City: Mora
State: Minnesota
ZIP Code: 55051-1553
Phone: (320) 438-4493

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Driver	172A00000X	Primary

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