Active NPI
Katherine V Peterson, RD
- Registered Dietitian
- Waukesha, WI
National Provider Identifier
1164076345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 3414-29
- Practice address
- 302 W North St Apt 26
Waukesha, WI 53188-5142 - Phone
- (630) 605-6265
- NPI assigned
- Jul 26, 2019
- 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 Dietitian | 133V00000X | 3414-29 | WI | Primary |
Addresses
Primary practice location
302 W North St Apt 26
Waukesha, WI 53188-5142
Mailing address
302 W North St Apt 26
Waukesha, WI 53188-5142
Phone (630) 605-6265
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3414-29 | WI | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bienetre Medical PC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564099200000",
"number": "1164076345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 W NORTH ST APT 26",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531885142",
"telephone_number": "630-605-6265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 W NORTH ST APT 26",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531885142",
"telephone_number": "630-605-6265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KATHERINE",
"middle_name": "V",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-26",
"last_updated": "2019-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WI",
"license": "3414-29",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.