Active NPI
Jena K Doemel
- Registered Dietitian
- Marinette, WI
National Provider Identifier
1104228220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2732
- Practice address
- 3100 Shore Dr
Marinette, WI 54143-4242 - Phone
- (715) 732-4200
- NPI assigned
- Sep 19, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2502 | MN | |
| Registered Dietitian | 133V00000X | 2732 | WI | Primary |
Addresses
Primary practice location
3100 Shore Dr
Marinette, WI 54143-4242
Mailing address
PO Box 55
Peshtigo, WI 54157-0055
Phone (715) 801-0293
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2732 | WI | MD | Psychologist |
| 2502 | MN | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411084800000",
"number": "1104228220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 55",
"city": "PESHTIGO",
"state": "WI",
"postal_code": "541570055",
"telephone_number": "715-801-0293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 SHORE DR",
"city": "MARINETTE",
"state": "WI",
"postal_code": "541434242",
"telephone_number": "715-732-4200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOEMEL",
"first_name": "JENA",
"middle_name": "K",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-19",
"last_updated": "2014-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "2502",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WI",
"license": "2732",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marinette, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.