Individual provider Active NPI

Kaelin Joy Petzel, RN

  • School Registered Nurse
  • Superior, WI
National Provider Identifier
1568303808
Registry record updated Apr 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Registered NurseTaxonomy code 163WS0200X
License
1105432-30 Issued in WI
Practice address
3626 Hammond Ave
Superior, WI 54880-4483
Phone
(715) 394-8757
Fax
(715) 395-8483
NPI assigned
Apr 2, 2026
Last updated
Apr 2, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered Nurse 163WS0200X 1105432-30 WI Primary

Addresses

Primary practice location

3626 Hammond Ave
Superior, WI 54880-4483

Mailing address

3626 Hammond Ave
Superior, WI 54880-4483
Phone (715) 394-8757

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

LicenseStateTypeSpecialty
1105432-30WIMDSchool Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1775088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775088000000",
    "number": "1568303808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3626 HAMMOND AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548804483",
            "telephone_number": "715-394-8757",
            "fax_number": "715-395-8483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3626 HAMMOND AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548804483",
            "telephone_number": "715-394-8757",
            "fax_number": "715-395-8483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETZEL",
        "first_name": "KAELIN",
        "middle_name": "JOY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-02",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "WI",
            "license": "1105432-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Superior, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; 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.