Petersen, Michelle K

Petersen, Michelle K is an individual health care provider with primary practice located at 5300 Memorial Dr , Two Rivers WI 54241. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Petersen, Michelle K can be contacted via phone (920) 793-7400.

Contact Information

Primary practice address
5300 Memorial Dr Two Rivers WI 54241
Phone: (920) 793-7400
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 8589-033 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 8589-33 Wisconsin

Profile Details

NPI number 1700041472
LBN Legal business name Petersen, Michelle K
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2008
Last updated Nov 30th, 2021 - about 5 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 1700041472 NPPES
Wisconsin MEDICAID 100080774

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