Healthcare Provider Details

I. General information

NPI: 1487637658
Provider Name (Legal Business Name): JUNE MARIE PETERS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUNE MARIE RICKABY NP

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S MAIN ST STE 2
OCONTO FALLS WI
54154-1282
US

IV. Provider business mailing address

835 S MAIN ST STE 2
OCONTO FALLS WI
54154-1282
US

V. Phone/Fax

Practice location:
  • Phone: 920-846-9995
  • Fax: 920-846-8031
Mailing address:
  • Phone: 920-846-9995
  • Fax: 920-846-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number52609-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1296-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number52609-030
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1296-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: