Provider Demographics
NPI:1093937807
Name:RADAVICH, REGINE MARIE-PIERRE (RCS RN)
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:MARIE-PIERRE
Last Name:RADAVICH
Suffix:
Gender:F
Credentials:RCS RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6496 37TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53950
Mailing Address - Country:US
Mailing Address - Phone:608-562-5775
Mailing Address - Fax:608-562-5775
Practice Address - Street 1:W6496 37TH STREET
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:WI
Practice Address - Zip Code:53950
Practice Address - Country:US
Practice Address - Phone:608-562-5775
Practice Address - Fax:608-562-5775
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40002600Medicaid