Individual provider Active NPI

Cheryl M Habeck, NP

  • Family Nurse Practitioner
  • Menasha, WI
National Provider Identifier
1114912425
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1238 Issued in WI
Practice address
1550 Midway PL
Menasha, WI 54952-1165
Phone
(920) 727-8030
NPI assigned
Sep 13, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1238033 WI
Family Nurse Practitioner 363LF0000X 1238 WI Primary

Addresses

Primary practice location

1550 Midway PL
Menasha, WI 54952-1165

Mailing address

1550 Midway PL
Menasha, WI 54952-1165
Phone (920) 727-8030

Other identifiers 1

IdentifierTypeStateIssuer
43854900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20050707000930 WI Practitioner - Nurse Practitioner 1557307865 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1238WIMDPhysician Assistant
1238033WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oneida Nation CurrentSince May 16, 2005 Accepting new patients

Locations

525 Airport Dr
Oneida, WI 54155
Phone (920) 869-2711

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": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1114912425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 MIDWAY PL",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521165",
            "telephone_number": "920-727-8030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 MIDWAY PL",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521165",
            "telephone_number": "920-727-8030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABECK",
        "first_name": "CHERYL",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-13",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "1238033",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "1238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43854900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Menasha, WI

Sources for this page

Verify at the official NPI Registry.