Fusae Mary Wicks, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

813615 Issued in NV

Practice address

4560 S Eastern Ave Ste 15
Las Vegas, NV 89119-6182

Phone

(702) 994-7267

Fax

(702) 623-5995

NPI assigned

Feb 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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

Specialty

Nurse Practitioner

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Meilan L Daguman Aprn PLLCGroup PAC ID 5496035180, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fusae.wicks.1@28155.direct.athenahealth.com

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.

• Meilan L Daguman Aprn PLLC

  • Primary Care Nurse Practitioner
  • Las Vegas, NV
  • NPI 1023568037
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1171065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1093856130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7104 CARMEN BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891283430",
            "telephone_number": "702-994-7267",
            "fax_number": "702-623-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 S EASTERN AVE STE 15",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196182",
            "telephone_number": "702-994-7267",
            "fax_number": "702-623-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKS",
        "first_name": "FUSAE",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-10",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NV",
            "license": "813615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barry D Wicklund
• Marissa Wicklund
• Shanika Roshanie Wickramarachchi
• Sienna Christine Wickramasekera, PA-C
• James Wicks-Stephens
• Patricia Jean Wicks
• Roamon Wicks
• Tina Wicks
• Shindena Widby
• Dana S Widdison, M.S.N, A.P.N., C.N.M

• Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.