Active NPI
Tracy Lynn Koltun, RN
- Home Health Registered Nurse
- Mequon, WI
National Provider Identifier
1316214901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Registered Nurse
- License
- 166720030
- Practice address
- 11120 N Range Line Rd
Mequon, WI 53092-4931 - Phone
- (262) 236-9147
- NPI assigned
- Nov 26, 2011
- 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 |
|---|---|---|---|---|
| Home Health Registered Nurse | 163WH0200X | 166720030 | WI | Primary |
Addresses
Primary practice location
11120 N Range Line Rd
Mequon, WI 53092-4931
Mailing address
11120 N Range Line Rd
Mequon, WI 53092-4931
Phone (262) 236-9147
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 |
|---|---|---|---|
| 166720030 | WI | MD | Home Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322265600000",
"number": "1316214901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11120 N RANGE LINE RD",
"city": "MEQUON",
"state": "WI",
"postal_code": "530924931",
"telephone_number": "262-236-9147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11120 N RANGE LINE RD",
"city": "MEQUON",
"state": "WI",
"postal_code": "530924931",
"telephone_number": "262-236-9147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLTUN",
"first_name": "TRACY",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-26",
"last_updated": "2011-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "163WH0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Home Health",
"state": "WI",
"license": "166720030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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.