Provider Demographics
NPI:1487637658
Name:PETERS, JUNE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:MARIE
Last Name:PETERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:MARIE
Other - Last Name:RICKABY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:835 S MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1282
Mailing Address - Country:US
Mailing Address - Phone:920-846-9995
Mailing Address - Fax:920-846-8031
Practice Address - Street 1:835 S MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1282
Practice Address - Country:US
Practice Address - Phone:920-846-9995
Practice Address - Fax:920-846-8031
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52609-030363L00000X, 363LW0102X
WI1296-33363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1851477913OtherCMH NPI
WI11014110Medicaid
WI1821216276OtherCLINIC NPI
WI11014110Medicaid
WI52Z310Medicare Oscar/Certification
WI1851477913OtherCMH NPI