Provider Demographics
NPI:1710422514
Name:MEVISSEN, RAEANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:RAEANN
Middle Name:
Last Name:MEVISSEN
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 1:1394B 220TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-6112
Mailing Address - Country:US
Mailing Address - Phone:715-781-3305
Mailing Address - Fax:
Practice Address - Street 1:1394B 220TH AVE
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-6112
Practice Address - Country:US
Practice Address - Phone:715-781-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN203706-8163W00000X
WI174347163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse