Paul Antonissen, APNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

8973-33 Issued in WI

Practice address

3957 Garrett St
De Pere, WI 54115-1655

Phone

(920) 471-3729

NPI assigned

Jan 7, 2019

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 7, 2019.

{
    "created_epoch": "1546819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1174096747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3957 GARRETT ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151655",
            "telephone_number": "920-471-3729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3957 GARRETT ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151655",
            "telephone_number": "920-471-3729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONISSEN",
        "first_name": "PAUL",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-07",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "8973-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in De Pere, WI
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.