Active NPI
Jacqueline A Gouge, APNP
- Nurse Practitioner
- Marinette, WI
National Provider Identifier
1982943494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 5222-33
- Practice address
- 2741 Roosevelt Rd
Marinette, WI 54143-3833 - Phone
- (715) 732-1392
- NPI assigned
- Feb 4, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 5222-33 | WI | Primary |
Addresses
Primary practice location
2741 Roosevelt Rd
Marinette, WI 54143-3833
Mailing address
3120 Riverside Ave
Gate B Building 1
Marinette, WI 54143-1123
Phone (715) 732-2078
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4704302472 | Other | MI | MICHIGAN LICENSE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5222 | WI | MD | Mental Health Counselor |
| 5222-33 | WI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395187200000",
"number": "1982943494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3120 RIVERSIDE AVE",
"address_2": "GATE B BUILDING 1",
"city": "MARINETTE",
"state": "WI",
"postal_code": "541431123",
"telephone_number": "715-732-2078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2741 ROOSEVELT RD",
"city": "MARINETTE",
"state": "WI",
"postal_code": "541433833",
"telephone_number": "715-732-1392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUGE",
"first_name": "JACQUELINE",
"middle_name": "A",
"credential": "APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-04",
"last_updated": "2014-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "5222-33",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MICHIGAN LICENSE",
"identifier": "4704302472",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marinette, WI
- Elaine Gavaras, NP
- Erika Marie Goddard, APNP
- Beth A Goetzman, APNP
- Goodwill Industries of Northern Wisconsin and Upper Michigan Inc.
- David Garrett Gossman, M.D.
- Erik K Graglia, OCCUPATIONAL THERAPI
- Alison Granquist, LCSW
- Great Blue Dental, LLC
- Great Lakes Heart and Vascular, LLC
- Nicholas Patrick Grimm, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.