Active NPI
Jacqueline M Herrenbruck, RN,RCS
- Registered Nurse
- Port Washington, WI
National Provider Identifier
1295979433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 166949-030
- Practice address
- 3164 Greenbay Road
Port Washington, WI 53074-9772 - Phone
- (262) 284-3679
- NPI assigned
- Apr 30, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 166949-030 | WI | Primary |
Addresses
Primary practice location
3164 Greenbay Road
Port Washington, WI 53074-9772
Mailing address
3164 Greenbay Road
Port Washington, WI 53074
Phone (262) 284-3679
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
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 166949-030 | WI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241049600000",
"number": "1295979433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3164 GREENBAY ROAD",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "53074",
"telephone_number": "262-284-3679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3164 GREENBAY ROAD",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530749772",
"telephone_number": "262-284-3679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRENBRUCK",
"first_name": "JACQUELINE",
"middle_name": "M",
"credential": "RN,RCS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-30",
"last_updated": "2009-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WI",
"license": "166949-030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Washington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.