Healthcare Provider Details

I. General information

NPI: 1356063291
Provider Name (Legal Business Name): HANNAH PETERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 N GRANDVIEW BLVD STE 102
WAUKESHA WI
53188-1672
US

IV. Provider business mailing address

2717 N GRANDVIEW BLVD STE 202
WAUKESHA WI
53188-1660
US

V. Phone/Fax

Practice location:
  • Phone: 877-906-9699
  • Fax: 888-483-0118
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95022054
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15340
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: