Provider Demographics
NPI:1053608992
Name:CHRISTIANSON, PEGGY S (APRN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:S
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17166 RUDY RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:WI
Mailing Address - Zip Code:54175-9635
Mailing Address - Country:US
Mailing Address - Phone:715-850-0700
Mailing Address - Fax:
Practice Address - Street 1:15397 STATE HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WI
Practice Address - Zip Code:54138-9702
Practice Address - Country:US
Practice Address - Phone:715-276-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily