Provider Demographics
NPI:1457682957
Name:PETERS, MARSHA (LPN)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-0366
Mailing Address - Country:US
Mailing Address - Phone:608-847-6568
Mailing Address - Fax:608-847-2577
Practice Address - Street 1:522 STATE ROAD 82 STE F
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1450
Practice Address - Country:US
Practice Address - Phone:608-847-6568
Practice Address - Fax:608-847-2577
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI303398 031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse