Jill M Grevenow, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

147817 Issued in WI

Practice address

999 N 92ND St
Pediatric Special Needs
Milwaukee, WI 53226-4875

Phone

(414) 337-7158

Fax

(414) 266-2926

NPI assigned

Sep 27, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jill M Wallander Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jgrevenow6709@direct.chw.org

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.

• Children'S Specialty Group, Inc.

  • Pediatrics Physician
  • Milwaukee, WI
  • NPI 1942970405
  Medicare reassignment NPD
• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment NPD

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

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375056000000",
    "number": "1124337043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 N 92ND ST",
            "address_2": "PEDIATRIC SPECIAL NEEDS",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264875",
            "telephone_number": "414-337-7158",
            "fax_number": "414-266-2926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 N 92ND ST",
            "address_2": "PEDIATRIC SPECIAL NEEDS",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264875",
            "telephone_number": "414-337-7158",
            "fax_number": "414-266-2926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREVENOW",
        "first_name": "JILL",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-27",
        "last_updated": "2013-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WI",
            "license": "147817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124337043",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "WALLANDER",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dawn Marie Gresham
• Brittany Gresl, PH.D.
• Susan K. Gresser, MSN, RN
• Lisa Ann Greuel
• Matthew Thomas Greulich, M.D.
• Martini Julia Grice, REGISTERED NURSE
• Maureen Marie Grichar, R.PH.
• Nicholas Jon Grider, LPN
• Tyler Paul Griebel, M.D.
• Jamie Gries, DPT

• Pediatric Nurse Practitioner in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Pediatric Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.