MR. DEREK DALE RAESE NPI 1205309226

NPI Information

NPI: 1205309226
Provider Name: MR. DEREK DALE RAESE
Classification: Licensed Practical Nurse - 164W00000X
Entity Type: Individual
Address:
16320 W MARIETTA DR
NEW BERLIN, WI
ZIP 53151
Phone: (414) 640-1112
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MR. Derek Dale Raese is a licensed practical nurse in New Berlin, WI. The provider is a licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. MR. Derek Dale Raese NPI is 1205309226. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

16320 W MARIETTA DR
NEW BERLIN, WI
ZIP 53151-594
Phone: (414) 640-1112

The enumeration date for this NPI number is 1/3/2019 and was last updated on 1/3/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	164W00000X	Licensed Practical Nurse		321484	WISCONSIN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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