JERALD DIETRICH CHARLES (NPI# 1396284154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396284154 |
| Entity Type | Individual |
| Full Name | JERALD DIETRICH CHARLES |
| Credential | PA-C |
| Practice Address |
2845 Greenbrier Rd Green Bay WI 54311-6519 |
| Mailing Address |
164 N. Broadway Green Bay WI 54303-2728 |
| Practice Telephone | 9202888320 |
| Mailing Telephone | 9204909046 |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2017-07-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2845 GREENBRIER RD |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54311-6519 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265435853 | Cynthia L Geocaris | Surgery | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2005-05-27 |
| 1659978872 | Molly Linzmeier | Registered Nurse | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-10-01 |
| 1588279756 | Toni M Pullen | Massage Therapist | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-09-14 |
| 1700413283 | Michelle Yvonne Degrave | Registered Nurse | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-03-25 |
| 1588299697 | Amanda Marie Steinfeldt | Nurse Practitioner | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-03-09 |
| 1659906113 | Kelly Jane Delzer | Nurse Practitioner | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-03-05 |
| 1750915815 | Jennifer Maronek | Occupational Therapist | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-02-27 |
| 1538792379 | Sierra R Milosch | Occupational Therapist | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2020-02-20 |
| 1205473584 | Mackenzie L Zuleger | Nurse Practitioner | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2019-12-05 |
| 1588214860 | Jessica S Thompson | Nurse Practitioner | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2019-09-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295333847 | Karen Ginnow | Pharmacist | Walmart #1908, 2292 Main St, Green Bay, WI 54311 | 2020-10-15 |
| 1639786551 | Maggie Hall | Dental Hygienist | 2633 Development Dr. Ste 40, Green Bay, WI 54311 | 2020-09-24 |
| 1295370807 | Jennifer Marie Arendt | Technician | 2970 Mossy Oak Cir #39, Green Bay, WI 54311 | 2019-11-07 |
| 1518508803 | Cheryl Ann Johnson | Specialist | 830 Edgewood Dr., Green Bay, WI 54311 | 2019-10-08 |
| 1124670898 | Robert H Wagner Family Dentist S.c. | Dentist | 2830 Curry Court, Suite 1, Green Bay, WI 54311 | 2019-07-12 |
| 1821659624 | The Salvation Army | Counselor | The Salvation Army Ray & Joan Kroc Center, 1315 Lime Kiln Road, Green Bay, WI 54311 | 2019-06-24 |
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1861916769 | Atlas Spinal Care | Chiropractor | 2069 Central Ct, Suite 11, Green Bay, WI 54311 | 2017-08-01 |
| 1851844161 | Green Bay Family Dental LLC | Dentist | 2609 Development Dr., Green Bay, WI 54311 | 2016-08-03 |
| 1710382809 | Betsy Hoida | Pharmacist | 2485 Greenbrier Rd., Green Bay, WI 54311 | 2014-10-31 |
| Find all providers in zip 54311 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215932439 | Kristin N Schultz | Physician Assistant | 1715 Dousman Street, Green Bay, WI 54307-9070 | 2005-06-15 |
| 1689167942 | Marissa Adrian | Physician Assistant | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2018-06-12 |
| 1740718105 | Kelly Elizabeth Halbach | Physician Assistant | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2017-05-30 |
| 1831424118 | Angela Mk Brashears | Physician Assistant | 2502 S Ashland Ave, Green Bay, WI 54304-5252 | 2009-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821612045 | Cassidy Renee Thomas | Physician Assistant | 1111 Delafield St Ste 209, Waukesha, WI 53188-3403 | 2020-06-03 |
| 1982056768 | Luke Harbers | Physician Assistant | 6226 Bankers Rd Ste 11, Mount Pleasant, WI 53403-9799 | 2016-07-06 |
| 1093085664 | Abraham David Pacheco | Physician Assistant | 3246 S 35th St, Milwaukee, WI 53215-4156 | 2012-01-12 |
| 1346577954 | Darren Rosser | Physician Assistant | 2931 S 108th St, West Allis, WI 53227-3519 | 2009-11-03 |
| 1033359401 | Matthew S. Bay | Physician Assistant | 1818 N. Meade St Suite 240 West, Fox Valley Surgical Associates, Appleton, WI 54911-3496 | 2009-02-25 |
| 1265657068 | Surgical and Rehab Services Inc | Physician Assistant | E4051 Steven Way, Spring Green, WI 53588-9271 | 2007-04-16 |
| 1992844385 | Jill Ann Schumacher | Physician Assistant | 2265 90th St, Eau Claire, WI 54703-0181 | 2007-02-05 |
| 1609915073 | Brian Felix Robinson | Physician Assistant | S725 Turner Valley Rd, Mondovi, WI 54755-8331 | 2007-02-05 |
| 1124176383 | William Henry Price | Physician Assistant | 4819 5th Ave, Unit 2, Kenosha, WI 53140-2924 | 2007-01-06 |
| 1619032919 | Michael R Depew | Physician Assistant | 1650 S. 41st St., Lakeshore Orthopedics, Manitowoc, WI 54220 | 2006-12-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.