Physician Compare National (NPI:1902375470)

HEALTHCARE PROVIDER: NICOLE DANNENBERG

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1902375470
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8921346628
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190205000483
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BAUER
	Individual professional last name
Provider First Name	NICOLE
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MEDICAL COLLEGE OF WISCONSIN
	Individual professional's medical school
Graduation Year	2018
	Individual professional's medical school graduation year
Primary Specialty	ANESTHESIOLOGY ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	THE MEDICAL COLLEGE OF WISCONSIN INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	2668384371
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	1595
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	W180N8045 TOWN HALL RD
	Group Practice or individual's line 1 address
City	MENOMONEE FALLS
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	530513518
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y