Active NPI
Stacey Andresen
- Dental Hygienist
- Gwinn, MI
National Provider Identifier
1083104392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2902011657
- Practice address
- 301 Explorer St
Gwinn, MI 49841-2813 - Phone
- (906) 346-9275
- NPI assigned
- May 11, 2018
- Last updated
- May 11, 2018
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2902011657 | MI | Primary |
Addresses
Primary practice location
301 Explorer St
Gwinn, MI 49841-2813
Mailing address
2815 Wright St
Marquette, MI 49855-9694
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 |
|---|---|---|---|
| 2902011657 | MI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525996800000",
"number": "1083104392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2815 WRIGHT ST",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498559694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 EXPLORER ST",
"city": "GWINN",
"state": "MI",
"postal_code": "498412813",
"telephone_number": "906-346-9275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDRESEN",
"first_name": "STACEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-11",
"last_updated": "2018-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MI",
"license": "2902011657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gwinn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.