Individual
TIMOTHY LOU PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 775-3969
Mailing address
GUNDERSEN HEALTH SYSTEM, 1836 SOUTH AVENUE, LA CROSSE, WI 54601
(608) 775-3969
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
83542-30
WI
Other
Enumeration date
04/10/2018
Last updated
04/10/2018
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