Individual
LACEY E KRAACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDMS, RVT, RT(R)
Contact information
Practice address
2629 N 7TH ST, SHEBOYGAN, WI 53083-4932
(920) 451-5000
Mailing address
PO BOX 63, LAKE HUNTINGTON, NY 12752-0063
(210) 573-3327
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
346578
—
2471S1302X
Sonography Radiologic Technologist
Primary
94755
—
2471V0105X
Vascular Sonography Radiologic Technologist
94755
—
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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