Provider Demographics
NPI:1528858230
Name:DEMERATH, CARLYE RAE (MSN-FNP-BC)
Entity type:Individual
Prefix:
First Name:CARLYE
Middle Name:RAE
Last Name:DEMERATH
Suffix:
Gender:F
Credentials:MSN-FNP-BC
Other - Prefix:
Other - First Name:CARLYE
Other - Middle Name:RAE
Other - Last Name:PIERRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3700 E ZION LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-2736
Mailing Address - Country:US
Mailing Address - Phone:920-841-2731
Mailing Address - Fax:920-738-6299
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-454-2169
Practice Address - Fax:920-738-6299
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI254099-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse