Individual
MR. DEREK QUELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2000 DOMANIK DR, RACINE, WI 53404-2910
(262) 633-4800
Mailing address
2000 DOMANIK DR, RACINE, WI 53404-2910
(262) 633-4800
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
176284-30
WI
Other
Enumeration date
08/14/2012
Last updated
05/15/2013
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