Provider Demographics
NPI:1023775558
Name:CRAKER, KELSI MARIE (RN)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:MARIE
Last Name:CRAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:
Other - Last Name:RUFENACHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:S1411 SUMMIT POINT DR
Mailing Address - Street 2:
Mailing Address - City:LA VALLE
Mailing Address - State:WI
Mailing Address - Zip Code:53941-9560
Mailing Address - Country:US
Mailing Address - Phone:608-333-3243
Mailing Address - Fax:
Practice Address - Street 1:557 S WINSTED ST
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588-9435
Practice Address - Country:US
Practice Address - Phone:608-963-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI254197163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health