Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

NPI 1063821502

Individual provider · NPI 1063821502 Deactivated

This NPI was deactivated on September 29, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1063821502 is a Nurse Practitioner. Qualified in 2014, 12 years ago. Practices with Sequoia Integrative Medical Services LLC, a 15-clinician group and accepts Medicare assignment.

Years since qualifying
12
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Practice location Incomplete address

The federal record is missing the street or ZIP for this provider.

No coordinates on file. Search this address in Google Maps

Specialties & licences

Record details

NPI number1063821502
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Sequoia Integrative Medical Services Llc — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Payments from drug and device companies, 2025

Drug and device makers are required by federal law (the Physician Payments Sunshine Act) to report what they pay or give to clinicians, and CMS publishes the reports as Open Payments. This is the 2025 program year. A report is a record of a payment, not an allegation of anything, and many are small items such as meals. Only general payments are listed here; research payments and ownership or investment interests are reported separately by CMS and are not shown.

Food and Beverage $29 1 payment · a meal or drink at a meeting or visit, not a fee

Each amount is the sum of what companies reported for that kind of payment in 2025, rounded to the dollar. Not all of it is income to the clinician: a meal is not a fee, a charitable contribution goes to a charity, and a royalty or an acquisition payment is not a salary.

Check a report, or dispute one, at the source in CMS’s own tool, Open Payments. Corrections go through CMS’s dispute process. This site removes a home address on request and asks for no proof, because that is privacy; it will not remove an accurate payment report on request, because that is a statutory public disclosure.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician. Those with a page here are linked.

  • Bristol Hospice Green Bay Hospice · Green Bay, WI · listed as Bristol Hospice - Green Bay, LLC
  • Door County Medical Center Hospital · Sturgeon Bay, WI
  • Holy Family Memorial Hospital · Manitowoc, WI
  • Ascension At Home Home health agency · Sturgeon Bay, WI
  • Ascension At Home Home health agency · Milwaukee, WI
  • Unity Hospice Hospice · De Pere, WI

Colleagues at Sequoia Integrative Medical Services LLC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 15 clinicians in the practice; 11 are shown here.