Provider Demographics
NPI:1043858525
Name:STARKE, RAQUEL LYNN
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:LYNN
Last Name:STARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12232 N RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2334
Mailing Address - Country:US
Mailing Address - Phone:414-640-9124
Mailing Address - Fax:
Practice Address - Street 1:12232 N RIDGE TRL
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2334
Practice Address - Country:US
Practice Address - Phone:414-640-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI245579163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics