Provider Demographics
NPI:1689909178
Name:DRAHEIM, MICHELLE LEANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEANNE
Last Name:DRAHEIM
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 1:601 FIELD CREST LN
Mailing Address - Street 2:
Mailing Address - City:BLACK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54106-9729
Mailing Address - Country:US
Mailing Address - Phone:920-984-4243
Mailing Address - Fax:920-984-4243
Practice Address - Street 1:601 FIELD CREST LN
Practice Address - Street 2:
Practice Address - City:BLACK CREEK
Practice Address - State:WI
Practice Address - Zip Code:54106-9729
Practice Address - Country:US
Practice Address - Phone:920-984-4243
Practice Address - Fax:920-984-4243
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167401-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse