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General NPI Number Information
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NPI Number | 1528858230
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Entity Type | Individual
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Provider Name | CARLYE RAE DEMERATH MSN-FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 1818 N MEADE ST
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City | APPLETON
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State | WI
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Zip | 54911-3454
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Country | US
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Telephone | 920-454-2169
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Fax | 920-738-6299
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Provider Business Mailing Address
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Address Line | 3700 E ZION LN
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City | APPLETON
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State | WI
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Zip | 54913-2736
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Country | US
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Telephone | 920-841-2731
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Fax | 920-738-6299
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 17213-33
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License Number State | WI
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