Active NPI
John Bradley Wakefield, RN
- Registered Nurse
- Superior, WI
National Provider Identifier
1013936731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R 152778-6
- Practice address
- 3600 Tower Ave
Superior, WI 54880-5337 - Phone
- (715) 392-1955
- Fax
- (715) 392-1935
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R 152778-6 | MN | Primary |
| Registered Nurse | 163W00000X | 138615-30 | WI |
Addresses
Primary practice location
3600 Tower Ave
Superior, WI 54880-5337
Mailing address
3600 Tower Ave
Superior, WI 54880-5337
Phone (715) 392-1955
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 152778-6 | MN | MD | Registered Nurse |
| 138615-30 | WI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345507200000",
"number": "1013936731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 TOWER AVE",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548805337",
"telephone_number": "715-392-1955",
"fax_number": "715-392-1935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 TOWER AVE",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548805337",
"telephone_number": "715-392-1955",
"fax_number": "715-392-1935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKEFIELD",
"first_name": "JOHN",
"middle_name": "BRADLEY",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2012-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "R 152778-6",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WI",
"license": "138615-30",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Superior, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.