Individual
MR. DEREK DALE RAESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16320 W MARIETTA DR, NEW BERLIN, WI 53151-6594
(414) 640-1112
Mailing address
568 N PALM ST, JANESVILLE, WI 53548-2845
(608) 718-3260
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
321484
WI
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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