Individual
REVA DECORAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
707 14TH ST, BARABOO, WI 53913-1539
(608) 356-1400
Mailing address
462 FUR LN, WISCONSIN DELLS, WI 53965-8646
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1111091-30
WI
Other
Enumeration date
11/21/2024
Last updated
11/21/2024
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