MR. KEITH J HACKER (NPI# 1952508400) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952508400 |
| Entity Type | Individual |
| Full Name | MR. KEITH J HACKER |
| Credential | P.A. |
| Practice Address |
1777 W Grand Ave Port Washington WI 53074-2077 |
| Practice Telephone | 2622843456 |
| Mailing Telephone | 2622843456 |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2016-10-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 523 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1952508400 | 05 |
| Street Address |
1777 W GRAND AVE |
| City | PORT WASHINGTON |
| State | WI |
| Zip Code | 53074-2077 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356332464 | Dawn M Zak | Counselor | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2005-10-31 |
| 1548791585 | Cameron Blegen | Family Medicine | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2017-03-22 |
| 1932565868 | Aurora Health Care Ventures Inc. | Eyewear Supplier (Equipment, not the service) | 1777 W Grand Ave, Suite 103, Port Washington, WI 53074-2077 | 2016-01-07 |
| 1699130732 | Rhiannon Jauer | Psychologist | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2015-12-16 |
| 1669855656 | Anjuli Marie Tuscano | Physician Assistant | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2015-07-08 |
| 1417247313 | Heidi S Wheeler | Nurse Practitioner | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2011-04-12 |
| 1427246370 | Aurora Advanced Healthcare, Inc. | Durable Medical Equipment & Medical Supplies | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2007-10-04 |
| 1730376617 | Aurora Advanced Healthcare, Inc. | Durable Medical Equipment & Medical Supplies | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2007-09-25 |
| 1558446971 | Advanced Healthcare, S.c. | Clinical Medical Laboratory | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2006-10-25 |
| 1629153101 | Advanced Healthcare, S.c. | Durable Medical Equipment & Medical Supplies | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2006-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962045864 | Heather Kay Brede | Technician | 857 Ashley Avenue, Port Washington, WI 53074 | 2019-10-23 |
| 1780062034 | Amanda Zitzer | Specialist/Technologist | 1037 S Spring Street, Apt 257, Port Washington, WI 53074 | 2015-05-07 |
| 1639507643 | Kelly Mulder | Occupational Therapy Assistant | 138 E Prospect St, Port Washington, WI 53074 | 2013-10-30 |
| 1235310921 | Susan Ann Dobberpuhl | Occupational Therapist | 306 N Sprint St, Port Washington, WI 53074 | 2007-11-21 |
| 1245444736 | Lee B Raffel | Social Worker | 3632 E Norport Drive, Port Washington, WI 53074 | 2007-05-10 |
| 1023143708 | Joshua E Leute | Dentist | 1317 West Grand Avenue, Port Washington, WI 53074 | 2007-02-22 |
| 1578633806 | Robert Andrew Kortsch | Dentist | 457 W Grand Ave, Port Washington, WI 53074 | 2006-11-08 |
| 1538256409 | Daniel P Witkowski | Dentist | 1612 N Wisconsin St, Port Washington, WI 53074 | 2006-10-10 |
| 1477584878 | Francine L Cosner | Obstetrics & Gynecology | 1777 W Grand Avenue, Port Washington, WI 53074 | 2006-07-05 |
| 1013953926 | Port Washington Podiatry Inc | Podiatrist | 1317 W Grand Avenue, Port Washington Podiatry, Port Washington, WI 53074 | 2006-06-20 |
| Find all providers in zip 53074 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407324858 | Samantha Caitlin Reichenbach | Physician Assistant | 16 Birchdale Ln, Port Washington, NY 11050-4502 | 2018-11-04 |
| 1043644719 | Jessica Kristine Conmey | Physician Assistant | 1329 W Grand Ave Ste 4, Port Washington, WI 53074-2010 | 2013-08-29 |
| 1538452149 | Mary C Noonan | Physician Assistant | 79 Avenue C, Port Washington, NY 11050-4210 | 2011-05-16 |
| 1669855656 | Anjuli Marie Tuscano | Physician Assistant | 1777 W Grand Ave, Port Washington, WI 53074-2077 | 2015-07-08 |
| 1861741365 | Alesha J Ewig | Physician Assistant | 1475 W Grand Ave, Port Washington, WI 53074-2074 | 2012-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043811409 | Kristen T Razner | Physician Assistant | 2500 E Capitol Dr # 3700, Appleton, WI 54911-8735 | 2020-11-03 |
| 1659986677 | Jordana Butler | Physician Assistant | 2105 E Enterprise Ave # 101, Appleton, WI 54913-7862 | 2020-09-15 |
| 1952916108 | Nicholas Allan Lueddecke | Physician Assistant | 101709 Fence Rd, Abbotsford, WI 54405-5400 | 2020-09-14 |
| 1073127049 | Dana Van De Hey | Physician Assistant | 616 White Birch Ct, Appleton, WI 54915-4516 | 2020-09-07 |
| 1386257194 | Harrison R Pham | Physician Assistant | 214 E Florida St Apt 526, Milwaukee, WI 53204-1657 | 2020-08-31 |
| 1366055063 | Clai Bishop Catto | Physician Assistant | 902c Tainter St, Menomonie, WI 54751-1546 | 2020-08-24 |
| 1003434978 | Benjamin Alton Cuvelier | Physician Assistant | 132 Cambridge Ave Apt 407, Waukesha, WI 53188-4788 | 2020-07-08 |
| 1366060295 | Sarah Anne Cook | Physician Assistant | 850 Brinsmere Dr, Elm Grove, WI 53122-2101 | 2020-07-07 |
| 1275159428 | Breanna Evert | Physician Assistant | 2320 Parklawn Dr # C111, Waukesha, WI 53186-2954 | 2020-06-23 |
| 1376168443 | Sadie Kolodziej | Physician Assistant | 401 Dewey Dr, Stevens Point, WI 54482-9655 | 2020-06-14 |
| Find all providers with the same taxonomy | ||||
| City | PORT WASHINGTON |
| Zip Code | 53074 |
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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.