Carol Jean Peterson, APNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4378-033 Issued in WI

Practice address

744 S Webster Ave
Green Bay, WI 54301-3505

Phone

(920) 445-7222

Fax

(920) 445-7238

NPI assigned

Apr 27, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Carol Jean Devine Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433462400000",
    "number": "1023309804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CAROL",
        "middle_name": "JEAN",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-27",
        "last_updated": "2015-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "4378-033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROL",
            "last_name": "DEVINE",
            "middle_name": "JEAN",
            "credential": "APNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amber N Petersen Kuemmel, RN, CRNA
• Kathryn Lynn Petersen, RN
• Alexander Lee Peterson, D-PT
• Ashley M Peterson, D.P.T.
• Brett Mychael Peterson, CRNA
• Jesse Frederick Peterson, PSYD
• Kristy A Peterson, CST
• Margaret Mary Peterson, OT
• Pebbles L Peterson, APSW
• Stephanie Marie Peterson, RN, BSN

• Nurse Practitioner in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.