{"npi":"1780192799","type":"NPI-1","status":"active","name":{"display":"Jesse Selestow","other":[{"code":"1","type":"Formerly known as","value":"MARK, JESSE"}],"first":"JESSE","last":"SELESTOW"},"specialty":{"primary_taxonomy":"363L00000X","primary_taxonomy_description":"Nurse Practitioner","slug":"nurse-practitioner","schema_org_specialty":null,"all":[{"code":"363L00000X","description":"Nurse Practitioner","primary":true,"state":"WI","license":"8208-33"}]},"addresses":[{"purpose":"LOCATION","street_1":"2801 W KINNICKINNIC RIVER PKWY STE 680","city":"MILWAUKEE","state":"WI","postal_code":"532153633","country_code":"US","phone":"4143851922"},{"purpose":"MAILING","street_1":"PO BOX 735044","city":"CHICAGO","state":"IL","postal_code":"606735044","country_code":"US","phone":"8003262250"}],"license":{"state":"WI","number":"8208-33"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"100074549","state":"WI","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20180125002385","type_code":"14-50","type_desc":"PRACTITIONER - NURSE PRACTITIONER","state":"WI","pac_id":"7618236365"}]},"enumeration_date":"2018-01-12","last_updated":"2024-01-22","_meta":{"source":"NPPES","snapshot_date":"2024-01-22","doc_url":"https://findmynpi.com/api"}}