Individual provider Active NPI

Tracy Weber

  • Addiction (Substance Use Disorder) Registered Nurse
  • Onalaska, WI
National Provider Identifier
1093259103
Registry record updated Jun 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X
License
220977-30 Issued in WI
Practice address
9532 E 16 Frontage Rd
Ste. 100
Onalaska, WI 54650-6739
Phone
(608) 783-0506
NPI assigned
Dec 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Registered Nurse 163WA0400X 220977-30 WI Primary

Addresses

Primary practice location

9532 E 16 Frontage Rd
Ste. 100
Onalaska, WI 54650-6739

Mailing address

9532 E 16 Frontage Rd
Ste. 100
Onalaska, WI 54650-6739
Phone (608) 783-0506

Other identifiers 1

IdentifierTypeStateIssuer
1003150004MedicaidWI

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
220977-30WIMDAddiction (Substance Use Disorder) Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1481155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496707200000",
    "number": "1093259103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9532 E 16 FRONTAGE RD",
            "address_2": "STE. 100",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546506739",
            "telephone_number": "608-783-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9532 E 16 FRONTAGE RD",
            "address_2": "STE. 100",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546506739",
            "telephone_number": "608-783-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBER",
        "first_name": "TRACY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-08",
        "last_updated": "2017-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "220977-30",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003150004",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Onalaska, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2017; 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.