Active NPI
Mary Rabideau, RN
- Registered Nurse
- Appleton, WI
National Provider Identifier
1174711311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 66017-030
- Practice address
- 10 Tri Park Way
Appleton, WI 54914-1658 - Phone
- (920) 831-0070
- NPI assigned
- Oct 12, 2007
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 66017-030 | WI | Primary |
Addresses
Primary practice location
10 Tri Park Way
Appleton, WI 54914-1658
Mailing address
10 Tri Park Way
Appleton, WI 54914-1658
Phone (920) 831-0070
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66017-030 | WI | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Milwaukee Vamc | Past | Accepting new patients |
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.
-
- Department of Veterans Affairs (VA) Pharmacy
- Appleton, WI
- NPI 1669643912
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192147200000",
"number": "1174711311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 TRI PARK WAY",
"city": "APPLETON",
"state": "WI",
"postal_code": "549141658",
"telephone_number": "920-831-0070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 TRI PARK WAY",
"city": "APPLETON",
"state": "WI",
"postal_code": "549141658",
"telephone_number": "920-831-0070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RABIDEAU",
"first_name": "MARY",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-12",
"last_updated": "2007-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WI",
"license": "66017-030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.