Unknown Individual – Registered Nurse, NPI 1669460671

Unknown Individual is a healthcare provider. based in Fond du lac, Wisconsin. specializing in Registered Nurse. They hold a License No. R140619-5 (MN). The NPI Number for Unknown Individual is 1669460671

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1669460671
Phone
(920) 926-8340
Address
420 E DIVISION ST
Deactivation Date
8 November 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9209292300
Graduation Year
2003 (23 years ago)
PAC ID
4486548344
Group Practice PAC ID
1658289624
Professional Enrollment ID
I20040211000622

Contacts

FHIR Endpoint
https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/
Secure Messaging
jrafferty331096@direct-ehr-ssmhc.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience37
Completeness85
Years active:0State licenses:3Other namesUpdated within 12 months

Loading map...

Provider Addresses for Unknown Individual

  • Fond-du-Lac, Northern Saskatchewan Administration District, Saskatchewan, Canada

    FOND DU LAC, WI 549354560

    Phone: (920) 926-8340

    Fax: (920) 926-8370

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 54935)

Loading plans...

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: 1658289624View full group profile
NameSpecialtyState
Emergency Medicine, Internal MedicineWI
Certified Registered Nurse Anesthetist (Crna)WI
-WI
U R O L O G YWI
-WI
P S Y C H I A T R YWI
Certified Registered Nurse Anesthetist (Crna)WI
Vascular Surgery, General SurgeryWI
-ND
Nephrology, Internal MedicineWI

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1669460671.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Registered Nurse for Unknown Individual. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Fond Du Lac, Wisconsin. Check all listed addresses for suites or satellite offices.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.