Individual provider Active NPI

Wendy Wiersema, LPN

  • Licensed Practical Nurse
  • Dixon, IL
National Provider Identifier
1003363482
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
043037853 Issued in IL
Practice address
325 Il Route 2
Dixon, IL 61021-9118
Phone
(815) 284-6611
NPI assigned
Sep 2, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 043037853 IL Primary

Addresses

Primary practice location

325 Il Route 2
Dixon, IL 61021-9118

Mailing address

25559 Clark Rd
Chadwick, IL 61014-9289
Phone (815) 499-9072

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
043037853ILMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1003363482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25559 CLARK RD",
            "city": "CHADWICK",
            "state": "IL",
            "postal_code": "610149289",
            "telephone_number": "815-499-9072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 IL ROUTE 2",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610219118",
            "telephone_number": "815-284-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERSEMA",
        "first_name": "WENDY",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-02",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043037853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.