Individual
MOLLY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 E LAYTON AVE, ST FRANCIS, WI 53235-6053
(414) 744-6589
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 774-6589
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
71793-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100069057
—
WI
Enumeration date
04/12/2017
Last updated
05/15/2025
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