Doctor Name: | JOANNE M PETERSON |
NPI Number: | 1255335030 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 58398 |
Business Practice Address: | N66w25201 County Highway Vv Fast Care Clinic Sussex, WI - 530892677 |
Business Phone Number: | 2625328691 |
Business Fax Number: | |
Mailing Address: | N66w25201 County Highway Vv, Fast Care Clinic SUSSEX |
State: | WI |
Postal Code: | 530892677 |
Phone Number: | 2625328691 |
Fax Number: | |
NPI Enumeration Date: | 06/09/2005 |
NPI Last Update Date: | 07/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 58398 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |