Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2503 | WI |
NPI | 1124052451 |
---|---|
Provider Name | Ms. Raelyn Katherine Eannelli |
First Address | Fitchburg, WI 53711-4711 |
Second Address | Prairie Du Sac, WI 53578-1126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 13/09/2013 |