Provider Demographics
NPI:1285837393
Name:VON RAESFELD, DORLEEN JEAN (CDE)
Entity Type:Individual
Prefix:
First Name:DORLEEN
Middle Name:JEAN
Last Name:VON RAESFELD
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:
Other - First Name:DORLEEN
Other - Middle Name:JEAN
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1109 RICKENBACKER ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3462
Mailing Address - Country:US
Mailing Address - Phone:408-298-3719
Mailing Address - Fax:
Practice Address - Street 1:750 S BASCOM AVE
Practice Address - Street 2:DIABETES ED
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2603
Practice Address - Country:US
Practice Address - Phone:408-885-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN515321163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator