Individual
MR. MICHAEL ANDREW PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1615 MAPLE LANE, ASHLAND, WI 54806
(715) 682-4563
(715) 685-5108
Mailing address
PO BOX 1547, SEDALIA, MO 65307
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
80086030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44320400
—
WI
Enumeration date
03/14/2006
Last updated
07/08/2007
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