| NPI |
1891458105 |
The State code in the location of the provider
being identified. |
| Entity Type Code |
1 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Last Name Legal Name |
SIERRA |
The country code in the location address of the provider being identified. |
| Provider First Name |
BRDGET |
The telephone number associated with the location address of the provider being identified. |
| Provider Credential Text |
APNP |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider First Line Business Practice Location Address |
3520 NASSAU DR |
The date that a record was last updated or changed. |
| Provider Business Practice Location Address City Name |
BROOKFIELD |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Provider Business Practice Location Address State Name |
WI |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Postal Code |
530452013 |
The title or position of the authorized official. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
4403086962 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider Enumeration Date |
10/14/2021 |
|
| Last Update Date |
10/14/2021 |
|
| Provider Gender Code |
F |
|
| Healthcare Provider Taxonomy Code 1 |
363L00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider License Number 1 |
11329 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 1 |
WI |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The telephone number associated with the location address of the provider being identified. |
| Is Sole Proprietor |
N |
The date the provider was assigned a unique identifier (assigned an NPI). |
| NPI Certification Date |
10/14/2021 |
|