Individual provider Active NPI

Juanita Perez-Hall, LPN

  • Licensed Practical Nurse
  • Milwaukee, WI
National Provider Identifier
1205020021
Registry record updated Sep 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
305506 Issued in WI
Practice address
6413 N 106TH St
Milwaukee, WI 53224-5108
Phone
(414) 353-4004
NPI assigned
Sep 5, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 305506 WI Primary

Addresses

Primary practice location

6413 N 106TH St
Milwaukee, WI 53224-5108

Mailing address

6413 N 106TH St
Milwaukee, WI 53224-5108
Phone (414) 353-4004

Other identifiers 1

IdentifierTypeStateIssuer
35039500MedicaidWI

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

LicenseStateTypeSpecialty
305506WIMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188950400000",
    "number": "1205020021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6413 N 106TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532245108",
            "telephone_number": "414-353-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6413 N 106TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532245108",
            "telephone_number": "414-353-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ-HALL",
        "first_name": "JUANITA",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-05",
        "last_updated": "2007-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "305506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35039500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; 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.