Individual provider Active NPI

Nicole D Zunker, RN,APNP

  • Family Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1104580075
Registry record updated Mar 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11518-33 Issued in WI
Practice address
933 Waube LN
Green Bay, WI 54304-5521
Phone
(920) 548-9500
NPI assigned
Oct 27, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11518-33 WI Primary

Addresses

Primary practice location

933 Waube LN
Green Bay, WI 54304-5521

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7210

Other practice location 1

2015 Shawano Ave
Green Bay, WI 54303-2606
Phone (920) 592-9478

Other practice location 2

1976 Lime Kiln Rd
Green Bay, WI 54311-4417
Phone (920) 445-7377

Other identifiers 1

IdentifierTypeStateIssuer
F06210390OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS

Other names 1

  • Nicole Dina Jesperson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211112000392 WI Practitioner - Nurse Practitioner 2860881836 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

2015 Shawano Ave
Green Bay, WI 54303-2606
Phone (920) 592-9478

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
11518-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Current Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Nov 5, 2021 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Nov 5, 2021 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Nov 5, 2021 Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients

Locations

1976 Lime Kiln Rd
Green Bay, WI 54311
Phone (920) 406-9865

3263 Eaton Rd
Green Bay, WI 54311
Phone (920) 433-6000

933 Waube Ln
Green Bay, WI 54304
Phone (920) 548-9500

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

2015 Shawano Ave
Howard, WI 54303
Phone (920) 496-8110

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Interoperability endpoints

  • Direct secure messaging: nzunker924983@direct.emplifyhealth.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1104580075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 WAUBE LN",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045521",
            "telephone_number": "920-548-9500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2015 Shawano Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543032606",
            "country_code": "US",
            "telephone_number": "920-592-9478",
            "fax_number": "920-592-9479",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1976 Lime Kiln Rd",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543114417",
            "country_code": "US",
            "telephone_number": "920-445-7377",
            "fax_number": "920-592-9479",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZUNKER",
        "first_name": "NICOLE",
        "middle_name": "D",
        "credential": "RN,APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-27",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "11518-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ACADEMY OF NURSE PRACTITIONERS",
            "identifier": "F06210390",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "JESPERSON",
            "middle_name": "DINA",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.