Individual provider Active NPI

Hannah Noelle Juckem

  • Certified Registered Nurse Anesthetist
  • Green Bay, WI
National Provider Identifier
1578398541
Registry record updated Apr 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
251606-30 Issued in WI
Practice address
2845 Greenbrier Rd
Green Bay, WI 54311-6519
Phone
(262) 951-8089
Fax
(920) 288-4863
NPI assigned
Sep 7, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X J2500119401102 WI
Certified Registered Nurse Anesthetist 367500000X 251606-30 WI Primary
Critical Care Medicine Registered Nurse 163WC0200X 251606 WI

Addresses

Primary practice location

2845 Greenbrier Rd
Green Bay, WI 54311-6519

Mailing address

1035 Kepler Dr
Green Bay, WI 54311-8320
Phone (920) 490-9046

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250616002121 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 5193236248 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baycare Clinic LLPGroup PAC ID 4385554328, 197 clinicians

Practice addresses (Care Compare)

2845 Greenbrier Rd
Green Bay, WI 54311-6519
Phone (920) 288-8250

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
251606-30WIMDCertified Registered Nurse Anesthetist
J2500119401102WIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Clinic LLP Current Accepting new patients
Baycare Clinic LLP CurrentSince Jun 1, 2025 Accepting new patients

Locations

2253 W Mason St
Green Bay, WI 54303
Phone (920) 327-7000

1035 Kepler Dr
Green Bay, WI 54311

2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388

2581 Development Dr
Green Bay, WI 54311
Phone (920) 347-0400

1500 Arbor Way
Kaukauna, WI 54130
Phone (877) 229-2273

719 Doctors Ct
Oshkosh, WI 54901
Phone (920) 235-0066

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1725667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1578398541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118320",
            "telephone_number": "920-490-9046",
            "fax_number": "920-405-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 GREENBRIER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116519",
            "telephone_number": "262-951-8089",
            "fax_number": "920-288-4863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUCKEM",
        "first_name": "HANNAH",
        "middle_name": "NOELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-07",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "J2500119401102",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "251606-30",
            "primary": true
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "WI",
            "license": "251606",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.