Individual
CAROLYN PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3400 UNION AVE, SHEBOYGAN, WI 53081-8426
(920) 802-1910
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(920) 802-2100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1215988
IL
363A00000X
Physician Assistant
Primary
7647-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100256060
—
WI
Enumeration date
10/16/2023
Last updated
08/30/2024
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