Active NPI
Lori Komisar, RN-BSN
- Diabetes Educator Registered Nurse
- Brown Deer, WI
National Provider Identifier
1225514656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diabetes Educator Registered Nurse
- License
- 85501-30
- Practice address
- 9252 N Green Bay Rd
Brown Deer, WI 53209-1104 - Phone
- (414) 527-5261
- NPI assigned
- Jul 18, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diabetes Educator Registered Nurse | 163WD0400X | 85501-30 | WI | Primary |
Addresses
Primary practice location
9252 N Green Bay Rd
Brown Deer, WI 53209-1104
Mailing address
9252 N Green Bay Rd
Milwaukee, WI 53209-1104
Phone (414) 527-5261
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
| License | State | Type | Specialty |
|---|---|---|---|
| 85501-30 | WI | MD | Diabetes Educator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531872000000",
"number": "1225514656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9252 N GREEN BAY RD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532091104",
"telephone_number": "414-527-5261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9252 N GREEN BAY RD",
"city": "BROWN DEER",
"state": "WI",
"postal_code": "532091104",
"telephone_number": "414-527-5261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMISAR",
"first_name": "LORI",
"credential": "RN-BSN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-18",
"last_updated": "2018-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "163WD0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Diabetes Educator",
"state": "WI",
"license": "85501-30",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brown Deer, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.