Individual
TAYLOR RAE ROTHERHAM-DECREMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1920 LIBAL ST, GREEN BAY, WI 54301-2471
(920) 436-8691
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9464-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F07191161
AMERICAN ACADEMY OF NURSE PRACTITIONERS
—
Enumeration date
02/03/2020
Last updated
12/08/2022
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