Healthcare Provider Details

I. General information

NPI: 1942130950
Provider Name (Legal Business Name): RAE ANNE NILES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26325 WILMOT RD
TREVOR WI
53179-9701
US

IV. Provider business mailing address

1218 WILMOT AVE
TWIN LAKES WI
53181-9419
US

V. Phone/Fax

Practice location:
  • Phone: 262-862-2356
  • Fax:
Mailing address:
  • Phone: 262-877-2148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number156541-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: