MEDICARE: MS. MICHELLE R PETERSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	2581-033	WI
2	363LF0000X	Family Nurse Practitioner	2581-33	WI

General Provider Information

NPI Number	:	1669481032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE R PETERSON NP

Provider Business Mailing Address
First Line	:	856 FAIR ST
Second Line	:
City	:	MINERAL POINT
State	:	WI
Zip	:	53565-1409
Country	:	US
Telephone Number	:	608-987-5985
Fax Number	:

Provider Business Practice Location Address
First Line	:	856 FAIR ST
Second Line	:
City	:	MINERAL POINT
State	:	WI
Zip	:	53565-1409
Country	:	US
Telephone Number	:	608-987-5985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	03/25/2024

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