Provider Demographics
NPI:1093776999
Name:RAYMOND, MICHAEL LEE (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8809
Mailing Address - Country:US
Mailing Address - Phone:920-420-8377
Mailing Address - Fax:
Practice Address - Street 1:3121 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8809
Practice Address - Country:US
Practice Address - Phone:920-420-8377
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WG0000X, 163WP0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38335100Medicaid