Individual
SAMANTHA RADKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
W206N16731 BLACKBERRY CIR, UNIT 1525, JACKSON, WI 53037-8963
(262) 573-9328
Mailing address
W206N16731 BLACKBERRY CIR, UNIT 1525, JACKSON, WI 53037-8963
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
191522-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1122459243
—
WI
Enumeration date
12/01/2013
Last updated
02/20/2014
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