Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 9024 | WI |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN9358795 | FL |
N | 363LA2200X | Nurse Practitioner - Adult Health | APRN9358795 | FL |
NPI | 1013454164 |
---|---|
Provider Name | Dessia J Laxton-Reinke |
First Address | Stevens Point, WI 54481-3112 |
Second Address | Stevens Point, WI 54481-3112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2017 |
Last Update Date | 14/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
024699800 | (05) | FL |
Z34X2 | BLUE CROSS BLUE SHIELD (01) | FL |