Active NPI
Jacqueline Nordvall, PHARMD
- Pharmacist
- Burlington, WI
National Provider Identifier
1235762089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20109-40
- Practice address
- 680 Milwaukee Ave
Burlington, WI 53105-1346 - Phone
- (262) 767-0697
- NPI assigned
- Feb 20, 2020
- Last updated
- Feb 20, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20109-40 | WI | Primary |
Addresses
Primary practice location
680 Milwaukee Ave
Burlington, WI 53105-1346
Mailing address
680 Milwaukee Ave
Burlington, WI 53105-1346
Phone (262) 767-0697
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20109-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
680 Milwaukee Ave
Burlington, WI 53105
Phone (262) 767-0697
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582156800000",
"number": "1235762089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 MILWAUKEE AVE",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "531051346",
"telephone_number": "262-767-0697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 MILWAUKEE AVE",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "531051346",
"telephone_number": "262-767-0697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORDVALL",
"first_name": "JACQUELINE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-20",
"last_updated": "2020-02-20",
"certification_date": "2020-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "20109-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burlington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.