Active NPI
Cynthia Wetmore, M.D., PHD
- Pediatrics Physician
- Duluth, MN
National Provider Identifier
1184696189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 44137
- Practice address
- 1012 E 2ND St
Duluth, MN 55805-2200 - Phone
- (218) 249-5555
- NPI assigned
- Feb 3, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 30348 | MS | |
| Pediatrics Physician | 208000000X | 44137 | MN | Primary |
Addresses
Primary practice location
1012 E 2ND St
Duluth, MN 55805-2200
Mailing address
1012 E 2ND St
Duluth, MN 55805-2200
Phone (218) 249-5555
Other practice location 1
1919 E Thomas Rd
Phoenix, AZ 85016-7710
Phone (602) 933-0920
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 452400400 | Medicaid | MN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | him@slk.direct.slhduluth.com |
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)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44137 | MN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686009600000",
"number": "1184696189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 E 2ND ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558052200",
"telephone_number": "218-249-5555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 E 2ND ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558052200",
"telephone_number": "218-249-5555"
}
],
"practiceLocations": [
{
"address_1": "1919 E Thomas Rd",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850167710",
"country_code": "US",
"telephone_number": "602-933-0920",
"fax_number": "602-933-2492",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WETMORE",
"first_name": "CYNTHIA",
"name_prefix": "Dr.",
"credential": "M.D., PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-03",
"last_updated": "2023-06-06",
"certification_date": "2023-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MS",
"license": "30348",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "44137",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "452400400",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "him@slk.direct.slhduluth.com",
"affiliation": "N",
"address_1": "1012 E 2nd St",
"city": "Duluth",
"state": "MN",
"country_code": "US",
"postal_code": "558052200",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.