Healthcare Provider Details

I. General information

NPI: 1285826164
Provider Name (Legal Business Name): CHERYL A PETERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 MAPLE LANE MEMORIAL MEDICAL CENTER INC BEHAVIORAL HEALTH SERVICE
ASHLAND WI
54806
US

IV. Provider business mailing address

1615 MAPLE LANE MEMORIAL MEDICAL CENTER INC BEHAVIORAL HEALTH SERVICE
ASHLAND WI
54806
US

V. Phone/Fax

Practice location:
  • Phone: 715-685-5400
  • Fax: 715-685-5102
Mailing address:
  • Phone: 715-685-5400
  • Fax: 715-685-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: