Individual
STACIE 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) 906-5144
Mailing address
50 N PORTLAND ST, FOND DU LAC, WI 54935-3412
(920) 906-5144
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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