Nichole Lynn Smith, REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

149778-030 Issued in WI

Practice address

N1615 Poeppel Rd
Fort Atkinson, WI 53538-9329

Phone

(920) 397-7636

NPI assigned

Mar 20, 2006

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

State licenses

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328832000000",
    "number": "1891754834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N1615 POEPPEL RD",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535389329",
            "telephone_number": "920-397-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N1615 POEPPEL RD",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535389329",
            "telephone_number": "920-397-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "NICHOLE",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-20",
        "last_updated": "2012-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "149778-030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Samuel C Smith, PHD
• Nathan Spangler, CRNA
• Jenna N Specchio, SLP
• Sport & Spine Clinic of Fort Atkinson Limited Partnership
• Jennifer M Stafford, DDS

• Registered Nurse in Fort Atkinson, WI
• Providers in Fort Atkinson, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; 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.