Active NPI
Gloria Agnes Wall, RN
- Community Health Registered Nurse
- Prairie Du Chien, WI
National Provider Identifier
1386846657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Registered Nurse
- License
- 50568-30
- Practice address
- 225 N Beaumont Rd
Suite 306
Prairie Du Chien, WI 53821-1445 - Phone
- (608) 326-0230
- Fax
- (608) 326-0289
- NPI assigned
- May 31, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Community Health Registered Nurse | 163WC1500X | 50568-30 | WI | Primary |
Addresses
Primary practice location
225 N Beaumont Rd
Suite 306
Prairie Du Chien, WI 53821-1445
Mailing address
225 N Beaumont Rd
Suite 306
Prairie Du Chien, WI 53821-1445
Phone (608) 326-0230
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41861300 | Medicaid | WI | |
| 44005700 | Medicaid | WI |
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 |
|---|---|---|---|
| 50568-30 | WI | MD | Community Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386846657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 N BEAUMONT RD",
"address_2": "SUITE 306",
"city": "PRAIRIE DU CHIEN",
"state": "WI",
"postal_code": "538211445",
"telephone_number": "608-326-0230",
"fax_number": "608-326-0289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 N BEAUMONT RD",
"address_2": "SUITE 306",
"city": "PRAIRIE DU CHIEN",
"state": "WI",
"postal_code": "538211445",
"telephone_number": "608-326-0230",
"fax_number": "608-326-0289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "GLORIA",
"middle_name": "AGNES",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163WC1500X",
"taxonomy_group": "",
"desc": "Registered Nurse, Community Health",
"state": "WI",
"license": "50568-30",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41861300",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "44005700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prairie Du Chien, WI
- Victoria Rose Varo, PHARM.D
- Angela I Wagner, OTR
- Wal-Mart Stores East LP (Walmart Pharmacy 10-0882)
- Wal-Mart Stores East, LP (Vision Center 30-0882)
- Walgreen Co (Walgreens #10682)
- Crystal G Wallin, RN
- Weber Chiropractic Clinic SC
- Alan John Weber, D.C.
- Welter Family Dentistry, Inc.
- Beth R Welter, D.D.S.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.