Individual
ANDREA R PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2600 65TH AVENUE, OSCEOLA, WI 54020-3024
(715) 294-2111
(715) 294-5758
Mailing address
PO BOX 218, 2600 65TH AVENUE, OSCEOLA, WI 54020-3024
(715) 294-2111
(715) 294-2111
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
40815
WI
133V00000X
Registered Dietitian
898228
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
898228
CERTIFICATE
WI
Enumeration date
10/17/2007
Last updated
10/21/2010
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