Individual provider Active NPI

Kathryn Renae Seidl, NP

  • Pediatric Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1619247129
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
180915 Issued in WI
Practice address
999 N 92ND St
C-350
Milwaukee, WI 53226-4875
Phone
(414) 266-6943
Fax
(414) 266-2926
NPI assigned
Jan 1, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 180915 WI Primary

Addresses

Primary practice location

999 N 92ND St
C-350
Milwaukee, WI 53226-4875

Mailing address

999 N 92ND St
C-350
Milwaukee, WI 53226-4875
Phone (414) 266-6943

Other identifiers 1

IdentifierTypeStateIssuer
1619247129MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120306000283 WI Practitioner - Nurse Practitioner 5092974378 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4760WIMDPhysician Assistant
180915WIMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Specialty Group, Inc. CurrentSince Apr 18, 2024 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Feb 27, 2012 Accepting new patients

Locations

10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: kseidl13405@direct.chw.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1325376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340928000000",
    "number": "1619247129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 N 92ND ST",
            "address_2": "C-350",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264875",
            "telephone_number": "414-266-6943",
            "fax_number": "414-266-2926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 N 92ND ST",
            "address_2": "C-350",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264875",
            "telephone_number": "414-266-6943",
            "fax_number": "414-266-2926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEIDL",
        "first_name": "KATHRYN",
        "middle_name": "RENAE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-01",
        "last_updated": "2012-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WI",
            "license": "180915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619247129",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.