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NPI Code Detail

MEDICARE: LORI JEAN PETERSON NP

MEDICARE: LORI JEAN 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
1363LW0102XWomen's Health Nurse Practitioner121689-30WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1363LW0102XOTHERWITAXONOMY

General Provider Information

NPI Number : 1821191891
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI JEAN PETERSON NP
Provider Business Mailing Address
First Line : 1752 DORSET LN
Second Line :
City : NEW RICHMOND
State : WI
Zip : 54017-2452
Country : US
Telephone Number : 715-246-8365
Fax Number : 715-246-8298
Provider Business Practice Location Address
First Line : 1752 DORSET LN
Second Line :
City : NEW RICHMOND
State : WI
Zip : 54017-2452
Country : US
Telephone Number : 715-246-8365
Fax Number : 715-246-8298
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 03/25/2016

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Directions to “ LORI JEAN PETERSON NP” Practice Location

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