Individual
MOLLY G PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, IBCLC, RLC
Contact information
Practice address
530 N 108TH PL, WAUWATOSA, WI 53226-4253
(414) 231-9640
Mailing address
6109 73RD ST APT 201, KENOSHA, WI 53142-3561
(815) 761-6877
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
Other
Enumeration date
01/21/2019
Last updated
01/21/2019
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