Individual
LEAH R PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 W 3RD ST, KIMBERLY, WI 54136-1300
(920) 788-7680
Mailing address
617 E BREWSTER ST, APPLETON, WI 54911-3719
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
13279-33
WI
Other
Enumeration date
09/20/2022
Last updated
10/09/2024
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