Individual
SHIRLEY MARIE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10 TRI PARK WAY, APPLETON, WI 54914-1658
(920) 831-0070
(920) 831-7939
Mailing address
2670 PARK RD, GREENLEAF, WI 54126-9666
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
16432-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16432-031
LPN
WI
Enumeration date
07/31/2006
Last updated
07/08/2007
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