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General NPI Number Information
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NPI Number | 1205661402
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Entity Type | Individual
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Provider Name | BRENNA ANN PETERS DNP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 711 W ADAMS ST
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615-5052
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Country | US
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Telephone | 715-284-5361
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Fax |
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Provider Business Mailing Address
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Address Line | N7780 N LOWE CREEK RD
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City | HIXTON
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State | WI
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Zip | 54635-8711
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Country | US
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Telephone | 715-579-5042
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 15700-33
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License Number State | WI
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