Individual
BRETT MYCHAEL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 857-0894
Mailing address
2129 N CONNIES CT, APPLETON, WI 54914-1867
(920) 843-3556
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
196486
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
14142-33
WI
Other
Enumeration date
02/23/2023
Last updated
11/05/2024
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