Individual
MS. SALLY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
W4054 LINDEN DR, MALONE, WI 53049-1694
(641) 425-5187
Mailing address
W4054 LINDEN DR, MALONE, WI 53049-1694
(641) 425-5187
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P32556
IA
Other
Enumeration date
12/14/2009
Last updated
12/14/2009
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