Individual
MR. TODD DENNIS PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
130 S KNOWLES AVE, NEW RICHMOND, WI 54017-1727
(715) 246-3018
(715) 246-3019
Mailing address
2659 170TH AVE, EMERALD, WI 54013-8140
(715) 265-7425
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
078545
WI
Other
Enumeration date
01/14/2008
Last updated
04/18/2019
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