Mary E Peterson, CANP is a
Nurse Practitioner based in Stockholm, Wisconsin. Mary E Peterson is licensed to practice in Minnesota (license number 0360774) and her current practice location is
W12070 State Highway 35, Stockholm, Wisconsin. She can be reached at her office (for appointments etc.) via phone at
(715) 821-8532.
NPI number for Mary E Peterson is 1083621445 and her current mailing address is W12070 State Highway 35, Stockholm, Wisconsin. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1083621445.
Provider's Profile
| Full Name | Mary E Peterson |
|---|
| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Location | W12070 State Highway 35, Stockholm, Wisconsin |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1083621445
- Provider Enumeration Date: 08/01/2006
- Last Update Date: 01/23/2015
Medical Identifiers
Medical identifiers for Mary E Peterson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1083621445 | NPI | - | NPPES |
| 0404556 | Other | MN | MEDICA |
| 090M9PE | Other | MN | BLUE CROSS BLUE SHIELD |
| 243994800 | Medicaid | MN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363L00000X | Nurse Practitioner | 0360774 (Minnesota) | Primary |
| 363LA2200X | Nurse Practitioner - Adult Health | 4576-033 (Wisconsin) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mary E Peterson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mary E Peterson, CANP
W12070 State Highway 35,
Stockholm, WI 54769-6127
Ph: (715) 821-8532 | Mary E Peterson, CANP
W12070 State Highway 35,
Stockholm, WI 54769-6127
Ph: (715) 821-8532 |
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