Individual
KIM L PETERSHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CD
Contact information
Practice address
1313 FISH HATCHERY RD, MADISON, WI 53715-1911
(608) 252-8000
(608) 283-7192
Mailing address
1313 FISH HATCHERY RD, MADISON, WI 53715-1911
(608) 252-8000
(608) 283-7192
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
15-029
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1948
DEAN HEALTH INSURANCE
WI
Enumeration date
04/26/2006
Last updated
01/23/2018
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