Individual
LEANA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11333 W NATIONAL AVE, MILWAUKEE, WI 53227-3111
(414) 329-4979
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5962-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10043305
—
WI
Enumeration date
09/16/2014
Last updated
03/05/2024
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