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NPI Code Detail

MEDICARE: MS. CHRISTINE LEANNE PETERSON WATTS NP

MEDICARE:  MS. CHRISTINE LEANNE PETERSON WATTS  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner1241-33WI

General Provider Information

NPI Number : 1417405515
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRISTINE LEANNE PETERSON WATTS NP
Provider Business Mailing Address
First Line : 4730 W BLAZING STAR RD
Second Line :
City : FRANKLIN
State : WI
Zip : 53132-2213
Country : US
Telephone Number : 414-704-1271
Fax Number :
Provider Business Practice Location Address
First Line : 4730 W BLAZING STAR RD
Second Line :
City : FRANKLIN
State : WI
Zip : 53132-2213
Country : US
Telephone Number : 414-704-1271
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2016
Last Update Date : 10/30/2023

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Directions to “ MS. CHRISTINE LEANNE PETERSON WATTS NP” Practice Location

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