Provider Demographics
NPI:1477974251
Name:PLAGEMANN, DOUGLAS (RN)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:PLAGEMANN
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 1:219 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-2009
Mailing Address - Country:US
Mailing Address - Phone:414-526-5019
Mailing Address - Fax:
Practice Address - Street 1:219 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-2009
Practice Address - Country:US
Practice Address - Phone:414-526-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157349-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse