Healthcare Provider Details

I. General information

NPI: 1093776999
Provider Name (Legal Business Name): MICHAEL LEE RAYMOND RN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 SPRING VALLEY RD
OSHKOSH WI
54904-8809
US

IV. Provider business mailing address

3121 SPRING VALLEY RD
OSHKOSH WI
54904-8809
US

V. Phone/Fax

Practice location:
  • Phone: 920-420-8377
  • Fax:
Mailing address:
  • Phone: 920-420-8377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: