Active NPI
Robin Wawersik
- Acute Care Nurse Practitioner
- Dearborn, MI
National Provider Identifier
1003184268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 4704231812
- Practice address
- 18181 Oakwood Blvd Ste 207
Dearborn, MI 48124-5031 - Phone
- (313) 271-5565
- Fax
- (313) 271-1053
- NPI assigned
- Dec 2, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 4704231812 | MI | Primary |
Addresses
Primary practice location
18181 Oakwood Blvd Ste 207
Dearborn, MI 48124-5031
Mailing address
22939 Nowlin St
Dearborn, MI 48124
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160413002100 | MI | Order and Referring Only - Other (Physician) | 9830497551 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704231812 | MI | MD | Acute Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322784000000",
"number": "1003184268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22939 NOWLIN ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18181 OAKWOOD BLVD STE 207",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481245031",
"telephone_number": "313-271-5565",
"fax_number": "313-271-1053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAWERSIK",
"first_name": "ROBIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-02",
"last_updated": "2011-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "MI",
"license": "4704231812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.