Individual
KENNETH D PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-8700
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(920) 303-8700
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
198339-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100079117
—
WI
Enumeration date
04/16/2018
Last updated
10/26/2023
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