Provider Demographics
NPI:1851087530
Name:PETERSON-DRABEK, BRENDA JANE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JANE
Last Name:PETERSON-DRABEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8457 S 47TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9168
Mailing Address - Country:US
Mailing Address - Phone:414-841-9678
Mailing Address - Fax:
Practice Address - Street 1:8457 S 47TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9168
Practice Address - Country:US
Practice Address - Phone:414-841-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
WI119886163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No171400000XOther Service ProvidersHealth & Wellness Coach