Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 70107210 | WI |
NPI | 1144703653 |
---|---|
Provider Name | Quinton Jarrett Peters |
First Address | Appleton, WI 54915-1726 |
Second Address | Appleton, WI 54915-1726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2018 |
Last Update Date | 04/12/2019 |