Provider Demographics
NPI:1205339447
Name:PUPPE, RAY ROSS (LPN)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:ROSS
Last Name:PUPPE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1522
Mailing Address - Country:US
Mailing Address - Phone:414-687-5500
Mailing Address - Fax:
Practice Address - Street 1:1705 E MARION ST
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1522
Practice Address - Country:US
Practice Address - Phone:414-687-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI314422164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse