Individual
KATHLEEN M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 N PORTLAND ST, FOND DU LAC, WI 54935-3412
(920) 906-5100
Mailing address
50 N PORTLAND ST, FOND DU LAC, WI 54935-3412
(920) 906-5100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
164733-030
WI
Other
Enumeration date
08/25/2009
Last updated
08/25/2009
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