MR. Derek Dale Raese
NPI #1205309226 in New Berlin, Wisconsin
Provider Information
- NPI Number
- 1205309226
- Entity Type
- Individual
- Name
- MR. Derek Dale Raese
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Licensed Practical Nurse
- Enumeration Date
- Jan 3, 2019
- Last Updated
- Jan 3, 2019
Practice Location
- Address
- 16320 W MARIETTA DR
- City
- New Berlin
- State
- Wisconsin
- ZIP Code
- 53151-6594
- Phone
- (414) 640-1112
Specialties & Taxonomy Codes
| Specialty |
|---|
| Licensed Practical Nurse |
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