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General NPI Number Information
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NPI Number | 1144180548
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Entity Type | Individual
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Provider Name | LUKE T PETERSON
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Gender | Male
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Dates
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Enumeration Date | 11/17/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 2424 S 102ND ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-2106
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Country | US
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Telephone | 414-373-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S COACHLIGHT DR
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City | NEW BERLIN
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State | WI
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Zip | 53151-1450
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1759933
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License Number State | WI
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