Individual
JOANNE M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
N66W25201 COUNTY HIGHWAY VV, FAST CARE CLINIC, SUSSEX, WI 53089-2677
(262) 532-8691
Mailing address
N66W25201 COUNTY HIGHWAY VV, FAST CARE CLINIC, SUSSEX, WI 53089-2677
(262) 532-8691
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
58398
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255335030
—
WI
01
—
43859300
MEDICAID
—
Enumeration date
06/09/2005
Last updated
07/22/2013
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