KENNETH D PETERSON (NPI# 1386131324) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386131324 |
| Entity Type | Individual |
| Full Name | KENNETH D PETERSON |
| Credential | CRNA |
| Practice Address |
835 S Van Buren St Green Bay WI 54301-3526 |
| Mailing Address |
2804 Stantonsburg Rd Apt 3e Greenville NC 27834-7291 |
| Practice Telephone | 9204330111 |
| Mailing Telephone | 9209156483 |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2020-04-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 198339-30 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871565788 | Kenneth A Peterson | Optometrist | 911 Oak Park Blvd Ste 104, Pismo Beach, CA 93449-3406 | 2006-02-03 |
| 1912140351 | Kenneth Brian Peterson | Internal Medicine | 8757 E Bell Rd, Scottsdale, AZ 85260-1322 | 2009-04-15 |
| 1164646741 | Kenneth Roy Peterson | Chiropractor | 76 Fort Hill Rd, Groton, CT 06340-4333 | 2007-04-13 |
| 1386768265 | Kenneth Dean Peterson | Chiropractor | 1002 W Elm Ave, Hermiston, OR 97838-2711 | 2007-03-18 |
| 1083706659 | Kenneth B Peterson | Family Medicine | 113 Comanche Rd, Fort Meade, SD 57741-1002 | 2006-09-29 |
| 1053321497 | Kenneth L Peterson | Dentist | 165 Nw 1st Ave, John Day, OR 97845-1101 | 2006-08-08 |
| 1194744896 | Kenneth S Peterson | Nurse Practitioner | 26 Queen St, Worcester, MA 01610 | 2006-07-19 |
| 1144287707 | Kenneth P Peterson | Anesthesiology | 15910 Ventura Blvd, Suite 1502, Encino, CA 91436-2802 | 2006-04-27 |
| Street Address |
835 S VAN BUREN ST |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54301-3526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093707689 | Louis A Suarez | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2005-08-18 |
| 1114526530 | Keisha Vickman | Nurse Practitioner | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-10-19 |
| 1902416480 | Tyler William Shimek | Nurse Anesthetist, Certified Registered | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-08-09 |
| 1770100489 | Fuad Emile Zankoul | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-06-29 |
| 1942822473 | Brittany Elizabeth Pitsch | Nurse Anesthetist, Certified Registered | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-05-06 |
| 1669093175 | Lacey Renee Anderson | Student in an Organized Health Care Education/Training Program | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-05-06 |
| 1891320834 | Tarra Lynn Moran | Hospitalist | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-03-10 |
| 1780219238 | Shea A Sternhagen | Nurse Practitioner | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-03-05 |
| 1508490780 | Christopher Michael Robinson | Anesthesiology | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-02-26 |
| 1083250872 | Brandyn Robert Behnke | Registered Nurse | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2019-11-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386102465 | Parc Village Dental, LLC | Dentist | 2805 Libal Street, Suite A, Green Bay, WI 54301 | 2019-03-07 |
| 1598229478 | Shaina Marie Conner | Registered Nurse | 835 S Vanburen St, Green Bay, WI 54301 | 2019-01-25 |
| 1093298960 | Brown County | Case Management | 111 N. Jefferson Street, Green Bay, WI 54301 | 2018-09-07 |
| 1639609928 | Frontline Healthcare LLC | Specialist/Technologist, Other | 2221 S. Webster Ave. Suite 270, Greenbay, WI 54301 | 2017-06-19 |
| 1992242606 | Charmaine Rimple | Counselor | 526 South Monroe Avenue, Green Bay, WI 54301 | 2017-01-20 |
| 1962944819 | Rebecca Lucille Reinbold | Registered Nurse | 917 Catherine Street, Green Bay, WI 54301 | 2016-11-09 |
| 1730635061 | Melissa Kristof | Specialist/Technologist, Other | 1821 Sounth Webster Ave., Green Bay, WI 54301 | 2016-08-28 |
| 1255709747 | Vivian Sweetheart Bishop-cook | Counselor | 2920 South Webster Ave, Green Bay, WI 54301 | 2015-09-14 |
| 1881079960 | Chelsi S Weber | Registered Nurse | 2300 Riverside Dr., Ste 204, Green Bay, WI 54301 | 2015-07-30 |
| 1962816371 | Joelle M Hesse | Counselor | 630 Cherry St., Green Bay, WI 54301 | 2014-06-13 |
| Find all providers in zip 54301 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902416480 | Tyler William Shimek | Nurse Anesthetist, Certified Registered | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-08-09 |
| 1942822473 | Brittany Elizabeth Pitsch | Nurse Anesthetist, Certified Registered | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2020-05-06 |
| 1598305393 | Syphay Vongkhamchanh | Nurse Anesthetist, Certified Registered | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2020-01-09 |
| 1306480157 | Devin Calaway | Nurse Anesthetist, Certified Registered | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2019-11-05 |
| 1982253647 | Caralynn E Andrus | Nurse Anesthetist, Certified Registered | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2019-09-05 |
| 1497228571 | Kyle W Runningen | Nurse Anesthetist, Certified Registered | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2019-01-10 |
| 1821560996 | Matthew Kolonich | Nurse Anesthetist, Certified Registered | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2018-12-29 |
| 1154814671 | Heath Cruise Tolliver | Nurse Anesthetist, Certified Registered | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2018-06-09 |
| 1649773813 | Kweku D Arko-gilbert | Nurse Anesthetist, Certified Registered | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2018-03-14 |
| 1245732346 | Joshua P Douma | Nurse Anesthetist, Certified Registered | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2018-03-05 |
| Find all providers in GREEN BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.