Ray Ross Puppe, L.P.N.

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

314422 Issued in WI

Practice address

1705 E Marion St
Shorewood, WI 53211-1522

Phone

(414) 687-5500

NPI assigned

Mar 14, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1520985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520985600000",
    "number": "1205339447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 E MARION ST",
            "city": "SHOREWOOD",
            "state": "WI",
            "postal_code": "532111522",
            "telephone_number": "414-687-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 E MARION ST",
            "city": "SHOREWOOD",
            "state": "WI",
            "postal_code": "532111522",
            "telephone_number": "414-687-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUPPE",
        "first_name": "RAY",
        "middle_name": "ROSS",
        "name_prefix": "Mr.",
        "credential": "L.P.N.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-14",
        "last_updated": "2018-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "314422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Shorewood, WI
• Licensed Practical Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2018; 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.