Individual
MS. JACQUELYN MASSINGILL PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
N 4001 COUNTY HIGHWAY K, LOWELL, WI 53557
(920) 927-1793
Mailing address
N 4001 COUNTY HIGHWAY K, LOWELL, WI 53557
(920) 927-1793
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38250100
—
WI
Enumeration date
06/13/2006
Last updated
07/09/2007
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