Active NPI
Thomas Mark Johnson, RN
- General Practice Registered Nurse
- Scandinavia, WI
National Provider Identifier
1881069862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- License
- 69342-30
- Practice address
- N5733 Gurholt Lake Rd
Scandinavia, WI 54977-9736 - Phone
- (715) 467-2324
- NPI assigned
- Dec 2, 2015
- Last updated
- Dec 2, 2015
- 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 |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 69342-30 | WI | Primary |
Addresses
Primary practice location
N5733 Gurholt Lake Rd
Scandinavia, WI 54977-9736
Mailing address
N5733 Gurholt Lake Rd
Scandinavia, WI 54977-9736
Phone (715) 467-2324
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 |
|---|---|---|---|
| 69342-30 | WI | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1449014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449014400000",
"number": "1881069862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N5733 GURHOLT LAKE RD",
"city": "SCANDINAVIA",
"state": "WI",
"postal_code": "549779736",
"telephone_number": "715-467-2324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N5733 GURHOLT LAKE RD",
"city": "SCANDINAVIA",
"state": "WI",
"postal_code": "549779736",
"telephone_number": "715-467-2324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "THOMAS",
"middle_name": "MARK",
"name_prefix": "Mr.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-12-02",
"last_updated": "2015-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "WI",
"license": "69342-30",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scandinavia, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.