Carol A. Rafferty, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

472033 Issued in WI

Practice address

725 S Webster Ave
The Neuro Team
Green Bay, WI 54301-3500

Phone

(920) 433-7995

Fax

(920) 433-3458

NPI assigned

Feb 7, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419811200000",
    "number": "1669650107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23400",
            "address_2": "THE NEURO TEAM",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543053400",
            "telephone_number": "920-433-7995",
            "fax_number": "920-433-3458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 S WEBSTER AVE",
            "address_2": "THE NEURO TEAM",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013500",
            "telephone_number": "920-433-7995",
            "fax_number": "920-433-3458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAFFERTY",
        "first_name": "CAROL",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-07",
        "last_updated": "2014-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "472-33",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "65003",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "472033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43825200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Radiant Life, LLC
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• Andrew Chandler Radtke, MD
• Diane Radtke, PT
• Matthew Kyle Rafn, MD
• Brian R Raguse, PA
• Brianna Rahmlow
• Ashok Nand Rai, MD
• Carmel Joy Raihala, DC CCSP

• Adult Health Nurse Practitioner in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Adult Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; 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.