Provider Demographics
NPI:1598051179
Name:RADTKE, MARY CATHERINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:RADTKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STAR PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:54026-9213
Mailing Address - Country:US
Mailing Address - Phone:715-338-5959
Mailing Address - Fax:
Practice Address - Street 1:516 5TH ST
Practice Address - Street 2:
Practice Address - City:STAR PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:54026-9213
Practice Address - Country:US
Practice Address - Phone:715-338-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129728-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse