Active NPI
Geralyn Carol Dorn
- Respite Care
- Fort Atkinson, WI
National Provider Identifier
1104655356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Respite Care
- License
- D650-2836-1611-00
- Practice address
- 1217 Lillian St
Fort Atkinson, WI 53538-1530 - Phone
- (262) 613-2595
- NPI assigned
- Jul 27, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Respite Care | 385H00000X | D650-2836-1611-00 | WI | Primary |
Addresses
Primary practice location
1217 Lillian St
Fort Atkinson, WI 53538-1530
Mailing address
1217 Lillian St
Fort Atkinson, WI 53538-1530
Phone (262) 613-2595
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D650-2836-1611-00 | WI | MD | Respite Care |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722038400000",
"number": "1104655356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1217 LILLIAN ST",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535381530",
"telephone_number": "262-613-2595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1217 LILLIAN ST",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535381530",
"telephone_number": "262-613-2595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORN",
"first_name": "GERALYN",
"middle_name": "CAROL",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-27",
"last_updated": "2024-07-27",
"certification_date": "2024-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": "WI",
"license": "D650-2836-1611-00",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Atkinson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.