Provider Demographics
NPI:1598406977
Name:ST PETER, BRANDON M (NP)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:ST PETER
Suffix:
Gender:M
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:920-720-8200
Mailing Address - Fax:920-720-8007
Practice Address - Street 1:1136 WESTOWNE DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2175
Practice Address - Country:US
Practice Address - Phone:920-720-8200
Practice Address - Fax:920-720-8007
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI11867363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100199939Medicaid