Active NPI
Annette S Harris, NP
- Nurse Practitioner
- Mequon, WI
National Provider Identifier
1053839571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 8133
- Practice address
- 12203 Corporate Pkwy
Mequon, WI 53092-3388 - Phone
- (262) 387-8239
- NPI assigned
- Sep 5, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 8133 | WI | Primary |
Addresses
Primary practice location
12203 Corporate Pkwy
Mequon, WI 53092-3388
Mailing address
12203 Corporate Pkwy
Mequon, WI 53092-3388
Phone (262) 387-8239
Other names 1
- Annette S Goltz
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515628800000",
"number": "1053839571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12203 CORPORATE PKWY",
"city": "MEQUON",
"state": "WI",
"postal_code": "530923388",
"telephone_number": "262-387-8239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12203 CORPORATE PKWY",
"city": "MEQUON",
"state": "WI",
"postal_code": "530923388",
"telephone_number": "262-387-8239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "ANNETTE",
"middle_name": "S",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-05",
"last_updated": "2018-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "8133",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ANNETTE",
"last_name": "GOLTZ",
"middle_name": "S",
"credential": "NP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.