| Doctor Name: | MARY E PETERSON |
| NPI Number: | 1083621445 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CANP |
| License Number: | 4576-033 |
| Business Practice Address: | W12070 State Highway 35 Stockholm, WI - 547696127 |
| Business Phone Number: | 7158218532 |
| Business Fax Number: | 7155986202 |
| Mailing Address: | W12070 State Highway 35, STOCKHOLM |
| State: | WI |
| Postal Code: | 547696127 |
| Phone Number: | 7158218532 |
| Fax Number: | 7155986202 |
| NPI Enumeration Date: | 08/01/2006 |
| NPI Last Update Date: | 01/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4576-033 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |