Individual
TARA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
2654 S ONEIDA ST STOP 102, GREEN BAY, WI 54304-5337
(888) 938-3838
Mailing address
10001 W INNOVATION DR STE 200, MILWAUKEE, WI 53226-4851
(888) 838-3838
(888) 919-1083
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
197282-30
WI
363L00000X
Nurse Practitioner
Primary
15899-33
WI
Other
Enumeration date
11/21/2024
Last updated
12/13/2024
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