Active NPI
Sally Peterson, LPN
- Licensed Practical Nurse
- Malone, WI
National Provider Identifier
1821327263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- P32556
- Practice address
- W4054 Linden Dr
Malone, WI 53049-1694 - Phone
- (641) 425-5187
- NPI assigned
- Dec 14, 2009
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | P32556 | IA | Primary |
Addresses
Primary practice location
W4054 Linden Dr
Malone, WI 53049-1694
Mailing address
W4054 Linden Dr
Malone, WI 53049-1694
Phone (641) 425-5187
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 |
|---|---|---|---|
| P32556 | IA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260748800000",
"number": "1821327263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W4054 LINDEN DR",
"city": "MALONE",
"state": "WI",
"postal_code": "530491694",
"telephone_number": "641-425-5187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W4054 LINDEN DR",
"city": "MALONE",
"state": "WI",
"postal_code": "530491694",
"telephone_number": "641-425-5187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "SALLY",
"name_prefix": "Ms.",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-14",
"last_updated": "2009-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "IA",
"license": "P32556",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malone, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.