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Individual

WALTER RAE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
58 BIG DEER RUN, NEWFANE, VT 05345-9570
(802) 365-9499
Mailing address
58 BIG DEER RUN, NEWFANE, VT 05345-9570
(802) 365-9499

Taxonomy

Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
0260058372
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39911600
WI
Enumeration date
04/23/2010
Last updated
04/23/2010
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