Healthcare Provider Details

I. General information

NPI: 1093937807
Provider Name (Legal Business Name): REGINE MARIE-PIERRE RADAVICH RCS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W6496 37TH STREET
NEW LISBON WI
53950
US

IV. Provider business mailing address

W6496 37TH STREET
NEW LISBON WI
53950
US

V. Phone/Fax

Practice location:
  • Phone: 608-562-5775
  • Fax: 608-562-5775
Mailing address:
  • Phone: 608-562-5775
  • Fax: 608-562-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: