Jenna Rose Buckley, CD RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2286 Issued in WI

Practice address

3807 Spring St
Mount Pleasant, WI 53405-1667

Phone

(262) 687-6339

Fax

(262) 687-6345

NPI assigned

Sep 1, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jenna Rose Fortier Former name

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Aurora Medical Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukee, WI
  • NPI 1659599157
  NPD

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

{
    "created_epoch": "1314835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314835200000",
    "number": "1811278070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3807 SPRING ST",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534051667",
            "telephone_number": "262-687-6339",
            "fax_number": "262-687-6345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3807 SPRING ST",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534051667",
            "telephone_number": "262-687-6339",
            "fax_number": "262-687-6345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "JENNA",
        "middle_name": "ROSE",
        "credential": "CD RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-01",
        "last_updated": "2011-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WI",
            "license": "2286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "FORTIER",
            "middle_name": "ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jana Brown, PHARM D
• Michelle Brown
• Heather Lee Bruinsma, NP
• Anna Marie Bryan, PMHNP
• BSH, SC
• Rachael R Bunn, NP
• Amy Burke, MS, CF-SLP
• Hailey Burmeister, PA-C
• Tershelle Burrows
• Mark Byaliy, PA-C

• Registered Dietitian in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Registered Dietitian in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.