Jeremiah Mobisa Gwaro, APNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

8323-33 Issued in WI

Practice address

1505 North Drive
Winnebago, WI 54985

Phone

(920) 426-4310

NPI assigned

Jun 6, 2018

Sex

Male

Sole proprietor

No

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

Practice roles

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.

• West Grove Clinic, SC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wauwatosa, WI
  • NPI 1518167477
  NPD (past)
• Wisconsin Resource Center

  • Family Nurse Practitioner
  • Winnebago, WI
  • NPI 1669142949
  NPD (past)

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1265924161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "924 LONDON ST",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521933",
            "telephone_number": "651-503-7412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 NORTH DRIVE",
            "city": "WINNEBAGO",
            "state": "WI",
            "postal_code": "54985",
            "telephone_number": "920-426-4310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWARO",
        "first_name": "JEREMIAH",
        "middle_name": "MOBISA",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-06",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "8323-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raul M Dejesus, M.D.
• Alejandro A Eisma, MD
• Louis M Fulton, MD
• Carlo Gallo Gaanan, MD
• Susan Lisa Griswold, APNP
• Annette M Hart, PT
• Kimberly Sue Hoenecke, D.O.
• Deanna Lynn Kapitzke, APNP
• Randy M Kerswill, M.D.
• Stephanie Ann Kerswill, MD

• Family Nurse Practitioner in Winnebago, WI
• Providers in Winnebago, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.