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General NPI Number Information
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NPI Number | 1003660945
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Entity Type | Individual
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Provider Name | MATTHEW T DRAKAS RN
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Gender | Male
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 205 PARKER ST
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City | BOSCOBEL
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State | WI
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Zip | 53805-1642
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Country | US
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Telephone | 608-375-4112
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Fax |
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Provider Business Mailing Address
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Address Line | 205 PARKER ST
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City | BOSCOBEL
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State | WI
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Zip | 53805-1642
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Country | US
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Telephone | 608-375-4112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 248849-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 15422
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License Number State | WI
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