Healthcare Provider Details

I. General information

NPI: 1679302376
Provider Name (Legal Business Name): CAITLYN MARIE RAATZ CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 S 60TH ST
WEST ALLIS WI
53214-3369
US

IV. Provider business mailing address

231 W WISCONSIN AVE APT 1204
MILWAUKEE WI
53203-2310
US

V. Phone/Fax

Practice location:
  • Phone: 414-291-2626
  • Fax:
Mailing address:
  • Phone: 608-780-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM09620
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: