Active NPI
Mary Helen Wieczorek, ATC/LAT
- Athletic Trainer
- Milwaukee, WI
National Provider Identifier
1023536877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1420-39
- Practice address
- 770 N 12TH St
Milwaukee, WI 53233-2203 - Phone
- (414) 288-0328
- Fax
- (414) 288-6477
- NPI assigned
- Aug 31, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1420-39 | WI | Primary |
Addresses
Primary practice location
770 N 12TH St
Milwaukee, WI 53233-2203
Mailing address
4050 S Lake Dr Apt 3
St Francis, WI 53235-5255
Phone (414) 759-1773
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1420-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592179200000",
"number": "1023536877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4050 S LAKE DR APT 3",
"city": "ST FRANCIS",
"state": "WI",
"postal_code": "532355255",
"telephone_number": "414-759-1773",
"fax_number": "414-288-6477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "770 N 12TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532332203",
"telephone_number": "414-288-0328",
"fax_number": "414-288-6477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIECZOREK",
"first_name": "MARY",
"middle_name": "HELEN",
"credential": "ATC/LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-31",
"last_updated": "2020-06-15",
"certification_date": "2020-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "1420-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.