Active NPI
Randal Gereau, LPN
- Licensed Practical Nurse
- Plymouth, WI
National Provider Identifier
1275825077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 313450-31
- Practice address
- 127 Beth Cir
Plymouth, WI 53073-2649 - Phone
- (920) 892-7044
- NPI assigned
- May 11, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 313450-31 | WI | Primary |
Addresses
Primary practice location
127 Beth Cir
Plymouth, WI 53073-2649
Mailing address
127 Beth Cir
Plymouth, WI 53073-2649
Phone (920) 892-7044
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 |
|---|---|---|---|
| 313450-31 | WI | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305072000000",
"number": "1275825077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "127 BETH CIR",
"city": "PLYMOUTH",
"state": "WI",
"postal_code": "530732649",
"telephone_number": "920-892-7044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "127 BETH CIR",
"city": "PLYMOUTH",
"state": "WI",
"postal_code": "530732649",
"telephone_number": "920-892-7044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEREAU",
"first_name": "RANDAL",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-11",
"last_updated": "2011-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "WI",
"license": "313450-31",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.