Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1154814671

Unknown Individual is a healthcare provider. based in De pere, Wisconsin. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 8658-33 (WI). The NPI Number for Unknown Individual is 1154814671

Main info

Organization
Inactive
8 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1154814671
Phone
(810) 691-0747
Address
445 GRANT ST
Deactivation Date
2 April 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7157174121
Graduation Year
2018 (8 years ago)
PAC ID
4385993427
Group Practice PAC ID
5092052118
Professional Enrollment ID
I20180822001798
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 445, Grant Street, West De Pere, De Pere, Brown County, Wisconsin, 54115, United States

    DE PERE, WI 541152106

    Phone: (810) 691-0747

    Type: Mailing

  • Bellin Hospital Green Bay, 744, South Webster Avenue, Astor, Green Bay, Brown County, Wisconsin, 54305, United States

    GREEN BAY, WI 543013505

    Phone: (920) 433-3605

    Fax: (920) 433-3589

    Type: Location

  • 835 S Van Buren St

    Green Bay, WI 543013526

    Phone: (920) 433-8488

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 54115)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5092052118View full group profile
NameSpecialtyState
-MN
Certified Registered Nurse Anesthetist (Crna)ID
Certified Registered Nurse Anesthetist (Crna)CO
-WI

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1154814671 uniquely identifies Unknown Individual in U.S. healthcare data.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Certified Registered Nurse Anesthetist in the taxonomy section. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to De Pere, Wisconsin in registry-derived data.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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