Healthcare Provider Details

I. General information

NPI: 1982253654
Provider Name (Legal Business Name): ALLISON L PETERSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON CHILDS PA-C

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 WINNEBAGO ST
MADISON WI
53704-5341
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-828-7603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7670-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12971
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: