{"npi":"1093781452","type":"NPI-1","status":"active","name":{"display":"Glenn Nickele MD","other":[],"first":"GLENN","last":"NICKELE","middle":"A","credential":"MD"},"specialty":{"primary_taxonomy":"207RC0000X","primary_taxonomy_description":"Cardiovascular Disease","slug":"cardiology","schema_org_specialty":"Cardiovascular","all":[{"code":"207RC0000X","description":"Cardiovascular Disease","primary":false,"state":"MN","license":"42548"},{"code":"207RC0000X","description":"Cardiovascular Disease","primary":true,"state":"WI","license":"32220"}]},"addresses":[{"purpose":"LOCATION","street_1":"216 S ADAMS ST","city":"SAINT CROIX FALLS","state":"WI","postal_code":"540249449","country_code":"US","phone":"7154833221","fax":"7154830507"},{"purpose":"MAILING","street_1":"235 STATE STREET","city":"ST. CROIX FALLS","state":"WI","postal_code":"540244117","country_code":"US","phone":"7154833261","fax":"7154830507"}],"license":{"state":"WI","number":"32220"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"468980100","state":"MN","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20040123000428","type_code":"14-06","type_desc":"PRACTITIONER - CARDIOVASCULAR DISEASE (CARDIOLOGY)","state":"WI","pac_id":"2567364128"},{"enrlmt_id":"I20120103000597","type_code":"14-06","type_desc":"PRACTITIONER - CARDIOVASCULAR DISEASE (CARDIOLOGY)","state":"MN","pac_id":"2567364128"}]},"enumeration_date":"2006-02-27","last_updated":"2024-06-12","_meta":{"source":"NPPES","snapshot_date":"2024-06-12","doc_url":"https://findmynpi.com/api"}}