Active NPI
Shelley L Peterson
- Home Health Registered Nurse
- West Bend, WI
National Provider Identifier
1861538340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Registered Nurse
- License
- 97651-030
- Practice address
- 6190 Congress Dr
West Bend, WI 53095-8103 - Phone
- (262) 675-6390
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Home Health Registered Nurse | 163WH0200X | 97651-030 | WI | Primary |
Addresses
Primary practice location
6190 Congress Dr
West Bend, WI 53095-8103
Mailing address
724 N Evans St
Sheboygan, WI 53081-3746
Phone (262) 388-5381
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 97651-030 | WI | MD | Home Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1861538340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "724 N EVANS ST",
"city": "SHEBOYGAN",
"state": "WI",
"postal_code": "530813746",
"telephone_number": "262-388-5381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6190 CONGRESS DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530958103",
"telephone_number": "262-675-6390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "SHELLEY",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-30",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "163WH0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Home Health",
"state": "WI",
"license": "97651-030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.