Juanita Nickelson

Primary specialty

Nursing Home AdministratorTaxonomy code 376G00000X

Practice address

2501 McKenna Blvd
Madison, WI 53711-3917

Phone

(414) 704-4217

NPI assigned

Feb 21, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• BW Home Health LLC

  • Home Health Agency
  • Madison, WI
  • NPI 1124612122
  NPD Authorized official

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

{
    "created_epoch": "1613865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613865600000",
    "number": "1659965606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "733 STRUCK ST UNIT 45617",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537443660",
            "telephone_number": "414-704-4217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 MCKENNA BLVD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537113917",
            "telephone_number": "414-704-4217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELSON",
        "first_name": "JUANITA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-21",
        "last_updated": "2021-02-21",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nursing Home Administrator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassidy Nicholson
• Andrew Christopher Nickel, MD
• Brian Thomas Nickel, M.D.
• Clara Nickel
• Ellen Puskala Nickel, APRN
• Nickles Counseling, LLC
• Carol Nickles, LCSW
• Peter J Nicksic, MD
• Victoria Brocksmith Nicksic, MD
• Elsa Nico, MD

• Nursing Home Administrator in Madison, WI
• Providers in Madison, WI by specialty
• Nursing Home Administrator in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2021; 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.