Individual
JANE ANNETTE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10 TRI PARK WAY, APPLETON, WI 54914-1658
(920) 831-0070
(920) 831-7939
Mailing address
N288 WOODSTOCK LN, APPLETON, WI 54915-3975
(920) 687-0769
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
194-023
WI
Other
Enumeration date
07/19/2006
Last updated
07/08/2007
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