Individual
DANIELLE MARIE REYSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCSH
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
111
WI
204R00000X
Electrodiagnostic Medicine Physician
3348
WI
247200000X
Other Technician
545
WI
2472E0500X
EEG Technician
3348
WI
Other
Enumeration date
05/22/2019
Last updated
05/22/2019
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