Individual
TRACY M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTIONER
Contact information
Practice address
3077 N MAYFAIR RD STE 305, WAUWATOSA, WI 53222-4305
(414) 384-6700
(414) 384-3008
Mailing address
2901 W KINNICKINNIC RIVER PKWY, SUITE 102, MILWAUKEE, WI 53215-3677
(414) 384-6700
(414) 384-3008
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2967-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36011500
—
WI
05
—
4126880
—
WI
Enumeration date
10/17/2006
Last updated
12/07/2023
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