Individual
TARA ANNE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
13950 W CAPITOL DR STE 200, BROOKFIELD, WI 53005-2441
(262) 781-3065
Mailing address
1300 N PROSPECT AVE APT 211, MILWAUKEE, WI 53202-3045
(720) 320-0790
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
6541-33
WI
Other
Enumeration date
08/17/2015
Last updated
08/17/2015
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