Individual
EMILY DIANA RAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
46399
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34471200
—
WI
Enumeration date
06/01/2005
Last updated
06/06/2016
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