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Individual provider Active NPI

Randi L Wagner, APNP

  • Family Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1205410040
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
10938-33 Issued in WI
Practice address
342 N Water St Ste 600
Milwaukee, WI 53202-5715
Phone
(651) 342-1039
Fax
(651) 342-1428
NPI assigned
May 7, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 10938-33 WI
Family Nurse Practitioner 363LF0000X 10938-33 WI Primary

Addresses

Primary practice location

342 N Water St Ste 600
Milwaukee, WI 53202-5715

Mailing address

270 Main St N Ste 300
Stillwater, MN 55082-6788
Phone (651) 342-1039

Other names 1

  • Randi L Ullrich Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210521002076 WI Practitioner - Nurse Practitioner 1759780877 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bluestone Physician Services Wisconsin SC 30 clinicians

Practice addresses (Care Compare)

342 N Water St
Suite 600
Milwaukee, WI 53202-5715
Phone (651) 342-1039

Hospital & facility affiliations

  • Ascension at Home Home health agency, Neenah, WI, CCN 527009
  • Bristol Hospice Green Bay Hospice, Green Bay, WI, CCN 521610
  • Unity Hospice Hospice, De Pere, WI, CCN 521503
  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160
  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bluestone Physician Services Wisconsin SC CurrentSince May 22, 2023 Accepting new patients

Locations

270 Main St N
Ste 300
Stillwater, MN 55082
Phone (651) 342-1039

342 N Water St
Ste 600
Milwaukee, WI 53202
Phone (414) 296-6189

Organizations & group practices 1

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1620345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777852800000",
    "number": "1205410040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 MAIN ST N STE 300",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826788",
            "telephone_number": "651-342-1039",
            "fax_number": "651-342-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 N WATER ST STE 600",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532025715",
            "telephone_number": "651-342-1039",
            "fax_number": "651-342-1428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "RANDI",
        "middle_name": "L",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-07",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "10938-33",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "10938-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RANDI",
            "last_name": "ULLRICH",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.