Active NPI
Jeanette Pahl
- Dental Hygienist
- Sturgeon Bay, WI
National Provider Identifier
1417764986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 11605-16
- Practice address
- 228 S 18TH Ave
Sturgeon Bay, WI 54235-1000 - Phone
- (920) 746-3788
- Fax
- (920) 743-3340
- NPI assigned
- Dec 17, 2024
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 11605-16 | WI | Primary |
Addresses
Primary practice location
228 S 18TH Ave
Sturgeon Bay, WI 54235-1000
Mailing address
5616 W Carlsville Rd
Sturgeon Bay, WI 54235-9741
Phone (920) 419-1924
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 |
|---|---|---|---|
| 11605-16 | WI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734393600000",
"number": "1417764986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5616 W CARLSVILLE RD",
"city": "STURGEON BAY",
"state": "WI",
"postal_code": "542359741",
"telephone_number": "920-419-1924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "228 S 18TH AVE",
"city": "STURGEON BAY",
"state": "WI",
"postal_code": "542351000",
"telephone_number": "920-746-3788",
"fax_number": "920-743-3340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAHL",
"first_name": "JEANETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-17",
"last_updated": "2024-12-17",
"certification_date": "2024-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WI",
"license": "11605-16",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sturgeon Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.