| Doctor Name: | GAIL PETERSON |
| NPI Number: | 1598195778 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 77261-30 |
| Business Practice Address: | 100 Polk County Plz Suite 180 Balsam Lake, WI - 548109071 |
| Business Phone Number: | 7154858500 |
| Business Fax Number: | 7154858501 |
| Mailing Address: | 100 Polk County Plz, Suite 180 BALSAM LAKE |
| State: | WI |
| Postal Code: | 548109071 |
| Phone Number: | 7154858500 |
| Fax Number: | 7154858501 |
| NPI Enumeration Date: | 11/25/2013 |
| NPI Last Update Date: | 11/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 77261-30 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |