Derek Dale Raese

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

321484 Issued in WI

Practice address

16320 W Marietta Dr
New Berlin, WI 53151-6594

Phone

(414) 640-1112

NPI assigned

Jan 3, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546473600000",
    "number": "1205309226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 N PALM ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482845",
            "telephone_number": "608-718-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16320 W MARIETTA DR",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531516594",
            "telephone_number": "414-640-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAESE",
        "first_name": "DEREK",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-03",
        "last_updated": "2019-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "321484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridget Quast
• Sarah Elizabeth Quesnell, D.D.S.
• Karla Michelle Quinones, AUD
• Jamie Lee Radant, LPC
• John Patrick Rader, LCSW
• Lauren Ramsey
• Marylyn S Ranta, M.D.
• Stephanie M. Rasmussen, CF-SLP
• David Campbell Raupp
• Meaghan Reaney, DO

• Licensed Practical Nurse in New Berlin, WI
• Providers in New Berlin, WI by specialty
• Licensed Practical Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.