Provider Demographics
NPI:1326081415
Name:PETERS, WENDY JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JEAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S53W34664 MORAINE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DOUSMAN
Mailing Address - State:WI
Mailing Address - Zip Code:53118-9008
Mailing Address - Country:US
Mailing Address - Phone:262-965-2395
Mailing Address - Fax:
Practice Address - Street 1:S53W34664 MORAINE HILLS DR
Practice Address - Street 2:
Practice Address - City:DOUSMAN
Practice Address - State:WI
Practice Address - Zip Code:53118-9008
Practice Address - Country:US
Practice Address - Phone:262-965-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56150-030163WH0200X, 163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39831800OtherRN HOME HEALTH