Tristan Philip Peterson, CERTIFIED SURGICAL T

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

License

167761 Issued in WI

Practice address

5200 Hummingbird Rd
Suite 100
Wausau, WI 54401-6312

Phone

(715) 359-6442

Fax

(715) 393-0390

NPI assigned

Feb 2, 2018

Last updated

Feb 2, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1517529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517529600000",
    "number": "1568961720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 HUMMINGBIRD RD.",
            "address_2": "SUITE 100",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544016312",
            "telephone_number": "715-359-6442",
            "fax_number": "715-393-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 HUMMINGBIRD RD",
            "address_2": "SUITE 100",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544016312",
            "telephone_number": "715-359-6442",
            "fax_number": "715-393-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TRISTAN",
        "middle_name": "PHILIP",
        "credential": "CERTIFIED SURGICAL T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-02",
        "last_updated": "2018-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "WI",
            "license": "167761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Mae Petersen
• Christopher G Peterson, MD
• Madalyn Ann Peterson, LCSW
• Shawna Marie Peterson
• Tracy Peterson, LPC
• Elizabeth Petesch
• Josip Petri, OTR/L
• John J Petronovich, M.D.
• Anna Mary Pfannes, CCC-SLP
• Sabrina Pfannsmith, CSFA

• Surgical Technologist in Wausau, WI
• Providers in Wausau, WI by specialty
• Surgical Technologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2018; 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.