NPIMap

Organization Active NPI

None

  • Registered Nurse
  • Greendale, WI
National Provider Identifier
1558601906
Registry record updated Feb 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
194720-30 Issued in WI
Legal business name
NONE
Practice address
6058 Oriole LN
Greendale, WI 53129-2552
Phone
(414) 241-7583
NPI assigned
Feb 21, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacquelyn Ksobiech
Title
Registered Nurse
Phone
(414) 241-7583

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X 194720-30 WI Primary

Addresses

Primary practice location

6058 Oriole LN
Greendale, WI 53129-2552

Mailing address

6058 Oriole LN
Greendale, WI 53129-2552

Other names 1

  • none Other name

National Provider Directory

National Provider Directory
Tax ID family
General Leonard Wood Army Community Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361404800000",
    "number": "1558601906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6058 ORIOLE LN",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531292552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6058 ORIOLE LN",
            "city": "GREENDALE",
            "state": "WI",
            "postal_code": "531292552",
            "telephone_number": "414-241-7583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NONE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-21",
        "last_updated": "2013-02-21",
        "status": "A",
        "authorized_official_last_name": "KSOBIECH",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_title_or_position": "REGISTERED NURSE",
        "authorized_official_telephone_number": "414-241-7583"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "194720-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "none",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.