Peterson, Tracy M

Peterson, Tracy M is an individual health care provider with primary practice located at 3077 N Mayfair Rd Ste 305 , Wauwatosa WI 53222-4305. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Peterson, Tracy M can be contacted via phone (414) 384-6700.

Contact Information

Primary practice address
3077 N Mayfair Rd Ste 305 Wauwatosa WI 53222-4305
Phone: (414) 384-6700
Fax: (414) 384-3008
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 2967-033 Wisconsin

Profile Details

NPI number 1619058740
LBN Legal business name Peterson, Tracy M
Credentials NURSE PRACTIONER
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 17th, 2006
Last updated Dec 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619058740 NPPES
Wisconsin MEDICAID 36011500
Wisconsin MEDICAID 4126880

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