Individual provider Active NPI

Mariellen Wazny, PAC

  • Medical Physician Assistant
  • Midland, MI
National Provider Identifier
1033138581
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601001316 Issued in MI
Practice address
3009 N Saginaw Rd
Midland, MI 48640-4555
Phone
(989) 633-1350
Fax
(989) 633-1353
NPI assigned
Jul 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601001316 MI Primary

Addresses

Primary practice location

3009 N Saginaw Rd
Midland, MI 48640-4555

Mailing address

3009 N Saginaw Rd
Midland, MI 48640-4555
Phone (989) 633-1350

Other identifiers 1

IdentifierTypeStateIssuer
1008807OtherMINCCPA# WAZNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601001316MIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Urgent Care Express PLLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033138581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3009 N SAGINAW RD",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486404555",
            "telephone_number": "989-633-1350",
            "fax_number": "989-633-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 N SAGINAW RD",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486404555",
            "telephone_number": "989-633-1350",
            "fax_number": "989-633-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAZNY",
        "first_name": "MARIELLEN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601001316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA# WAZNY",
            "identifier": "1008807",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.