Provider Demographics
NPI:1669915161
Name:PETERS, DANIEL JOHN (RN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:PETERS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 E MCMILLAN ST
Mailing Address - Street 2:MARSHFIELD
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-9111
Mailing Address - Country:US
Mailing Address - Phone:715-316-2677
Mailing Address - Fax:
Practice Address - Street 1:7027 E MCMILLAN ST
Practice Address - Street 2:MARSHFIELD
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-9111
Practice Address - Country:US
Practice Address - Phone:715-316-2677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI119963163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse