Provider Demographics
NPI:1417405515
Name:PETERSON WATTS, CHRISTINE LEANNE (NP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LEANNE
Last Name:PETERSON WATTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 W BLAZING STAR RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2213
Mailing Address - Country:US
Mailing Address - Phone:414-704-1271
Mailing Address - Fax:
Practice Address - Street 1:4730 W BLAZING STAR RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-2213
Practice Address - Country:US
Practice Address - Phone:414-704-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-17
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1241-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology