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General NPI Number Information
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NPI Number | 1669650107
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Entity Type | Individual
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Provider Name | CAROL A. RAFFERTY NP
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Gender | Female
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 725 S WEBSTER AVE THE NEURO TEAM
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City | GREEN BAY
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State | WI
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Zip | 54301-3500
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Country | US
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Telephone | 920-433-7995
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Fax | 920-433-3458
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Provider Business Mailing Address
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Address Line | PO BOX 23400 THE NEURO TEAM
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City | GREEN BAY
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State | WI
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Zip | 54305-3400
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Country | US
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Telephone | 920-433-7995
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Fax | 920-433-3458
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 472-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 65003
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 472033
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License Number State | WI
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