Individual
MRS. LACEY JO RAICHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3603 SCHNEIDER AVENUE, MENOMONIE, WI 54751-5674
(715) 233-6400
Mailing address
3603 SCHNEIDER AVENUE, MENOMONIE, WI 54751-5674
(715) 233-6400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R207746-8
MN
363LF0000X
Family Nurse Practitioner
Primary
162013-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679834857
—
MN
Enumeration date
06/04/2012
Last updated
03/31/2021
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