Active NPI
Kim A Peterson, RN
- Registered Nurse
- Marinette, WI
National Provider Identifier
1144408048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- Practice address
- 1116 Elizabeth Ave
Marinette, WI 54143-2515 - Phone
- (715) 732-2509
- NPI assigned
- Feb 4, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | WI | Primary |
Addresses
Primary practice location
1116 Elizabeth Ave
Marinette, WI 54143-2515
Mailing address
1116 Elizabeth Ave
Marinette, WI 54143-2515
Phone (715) 732-2509
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35052300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 155557-030 | WI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202083200000",
"number": "1144408048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1116 ELIZABETH AVE",
"city": "MARINETTE",
"state": "WI",
"postal_code": "541432515",
"telephone_number": "715-732-2509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1116 ELIZABETH AVE",
"city": "MARINETTE",
"state": "WI",
"postal_code": "541432515",
"telephone_number": "715-732-2509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KIM",
"middle_name": "A",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-04",
"last_updated": "2008-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WI",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "35052300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marinette, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.