Provider Demographics
NPI:1861893133
Name:ST PETER, ALICIA (APNP)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:ST PETER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:KLUMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:115 N SWEETWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2657
Mailing Address - Country:US
Mailing Address - Phone:920-476-6400
Mailing Address - Fax:
Practice Address - Street 1:2629 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4932
Practice Address - Country:US
Practice Address - Phone:920-451-5000
Practice Address - Fax:920-451-5333
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI196055163W00000X
WI7189-33363LF0000X
WI7189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100065455Medicaid