Active NPI
Shane Michael Peot, R.N.
- Registered Nurse
- De Pere, WI
National Provider Identifier
1740523828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 168533-030
- Practice address
- 1030 Countryside Dr
De Pere, WI 54115-1835 - Phone
- (920) 609-9883
- NPI assigned
- Mar 27, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 168533-030 | WI | Primary |
Addresses
Primary practice location
1030 Countryside Dr
De Pere, WI 54115-1835
Mailing address
1030 Countryside Dr
De Pere, WI 54115-1835
Phone (920) 609-9883
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
| License | State | Type | Specialty |
|---|---|---|---|
| 168533-030 | WI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364342400000",
"number": "1740523828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1030 COUNTRYSIDE DR",
"city": "DE PERE",
"state": "WI",
"postal_code": "541151835",
"telephone_number": "920-609-9883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 COUNTRYSIDE DR",
"city": "DE PERE",
"state": "WI",
"postal_code": "541151835",
"telephone_number": "920-609-9883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEOT",
"first_name": "SHANE",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-27",
"last_updated": "2013-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WI",
"license": "168533-030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in De Pere, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.