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General NPI Number Information
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NPI Number | 1821886607
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Entity Type | Individual
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Provider Name | ANDREA PETERSON RN
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Gender | Female
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 151 E BADGER RD SUITE A
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City | MADISON
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State | WI
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Zip | 53713
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Country | US
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Telephone | 608-250-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 1789 BRINGOLD DR
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City | VERONA
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State | WI
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Zip | 53593-8811
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Country | US
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Telephone | 815-299-7814
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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 | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 194813
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License Number State | WI
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