Provider Demographics
NPI:1669481032
Name:PETERSON, MICHELLE R (NP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:PETERSON
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 1:856 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53565-1409
Mailing Address - Country:US
Mailing Address - Phone:608-987-5985
Mailing Address - Fax:
Practice Address - Street 1:856 FAIR ST
Practice Address - Street 2:
Practice Address - City:MINERAL POINT
Practice Address - State:WI
Practice Address - Zip Code:53565-1409
Practice Address - Country:US
Practice Address - Phone:608-987-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2581-0332083X0100X
WI2581-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine