Individual
KIM A PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1116 ELIZABETH AVE, MARINETTE, WI 54143-2515
(715) 732-2509
Mailing address
1116 ELIZABETH AVE, MARINETTE, WI 54143-2515
(715) 732-2509
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35052300
—
WI
Enumeration date
02/04/2008
Last updated
02/04/2008
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