Provider Demographics
NPI:1932357084
Name:PETERS, NATALIE R (APNP, DNP)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:R
Last Name:PETERS
Suffix:
Gender:F
Credentials:APNP, DNP
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:R
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APNP, DNP
Mailing Address - Street 1:W165N5800 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-5655
Mailing Address - Country:US
Mailing Address - Phone:262-252-1060
Mailing Address - Fax:262-252-4807
Practice Address - Street 1:W165N5800 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-5655
Practice Address - Country:US
Practice Address - Phone:262-252-1060
Practice Address - Fax:262-252-4807
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932357084Medicaid
WI1932357084Medicaid