Bonnie Louise Penkwitz, CERTIFIED NURSING AS

Primary specialty

Home Health AideTaxonomy code 374U00000X

License

NA130482 Issued in WI

Practice address

121 W Main Street
Port Washington, WI 53074

Phone

(262) 284-8200

Fax

(262) 284-8103

NPI assigned

Feb 6, 2012

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 identifiers 1

Other names 1

• Bonnie Louise Hayes Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Science

State licenses

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

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328486400000",
    "number": "1902178981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 W MAIN STREET",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "53074",
            "telephone_number": "262-284-8200",
            "fax_number": "262-284-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W MAIN STREET",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "53074",
            "telephone_number": "262-284-8200",
            "fax_number": "262-284-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENKWITZ",
        "first_name": "BONNIE",
        "middle_name": "LOUISE",
        "credential": "CERTIFIED NURSING AS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-06",
        "last_updated": "2012-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "WI",
            "license": "NA130482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43111400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BONNIE",
            "last_name": "HAYES",
            "middle_name": "LOUISE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Home Health Aide in Port Washington, WI
• Providers in Port Washington, WI by specialty
• Home Health Aide in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.