Provider Demographics
NPI:1235150046
Name:RADTKE, JULEE R (NP)
Entity Type:Individual
Prefix:
First Name:JULEE
Middle Name:R
Last Name:RADTKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 S JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9057
Mailing Address - Country:US
Mailing Address - Phone:608-835-7113
Mailing Address - Fax:
Practice Address - Street 1:111 ANNA ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:WI
Practice Address - Zip Code:53594-1184
Practice Address - Country:US
Practice Address - Phone:920-478-3776
Practice Address - Fax:920-478-3979
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1357-033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13998OtherDEAN HEALTH CARE
WI20274908702OtherUNITY
WI43882600Medicaid
WI20274908702OtherUNITY