Individual
DOUGLAS MICHAEL DEDERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
W10741 BECKER RD, POYNETTE, WI 53955-9492
(608) 635-0113
Mailing address
W10741 BECKER RD, POYNETTE, WI 53955-9492
(608) 635-0113
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
148686
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35064600
—
WI
Enumeration date
08/07/2008
Last updated
08/07/2008
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