Individual provider Active NPI

Marquita Johniken, CRNP

  • Adult Health Nurse Practitioner
  • Dover, DE
National Provider Identifier
1093265902
Registry record updated Feb 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
LP-0000178 Issued in DE
Practice address
951 Forest St
Dover, DE 19904-3401
Phone
(302) 643-3966
Fax
(302) 643-3969
NPI assigned
Oct 4, 2016
Last updated
Feb 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X LP-0000178 DE Primary
Adult Health Nurse Practitioner 363LA2200X SP016557 PA

Addresses

Primary practice location

951 Forest St
Dover, DE 19904-3401

Mailing address

951 Forest St
Dover, DE 19904-3401
Phone (302) 643-3966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170628001017 DE Practitioner - Nurse Practitioner 7911283049 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

951 Forest St
Dover, DE 19904-3401
Phone (302) 784-5662

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP016557PAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
I Am Healthcare CurrentSince Nov 1, 2021 Accepting new patients

Locations

951 Forest St
Dover, DE 19904
Phone (302) 643-3966

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707523200000",
    "number": "1093265902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 FOREST ST",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199043401",
            "telephone_number": "302-643-3966",
            "fax_number": "302-643-3969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 FOREST ST",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199043401",
            "telephone_number": "302-643-3966",
            "fax_number": "302-643-3969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNIKEN",
        "first_name": "MARQUITA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-04",
        "last_updated": "2024-02-10",
        "certification_date": "2024-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "DE",
            "license": "LP-0000178",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP016557",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, DE

Sources for this page

Verify at the official NPI Registry.