Shane Peterson
Shane Peterson is a Driver in Mora, Minnesota. Practices as a sole proprietor. Registered with an NPI since 2021.
- In the registry since
- 2021
Practice location Address checks out
325 Watkins StMora, MN 55051-1553
Phone: (320) 438-4493
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Driver (primary) | Taxonomy 172A00000X |
|---|
Record details
| NPI number | 1972181246 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | March 30, 2021 |
| Last updated in NPPES | March 30, 2021 |
| Certification date | March 30, 2021 |
| Mailing address | 325 Watkins St, Mora, MN 55051-1553 |