Active NPI
Anne M. Wisbey
- Mental Illness Community Based Residential Treatment Facility
- Wallowa, OR
National Provider Identifier
1194049254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- 3111521345
- Practice address
- 104 South Alder St.
Wallowa, OR 97885 - Phone
- (541) 886-3039
- Fax
- (541) 886-3039
- NPI assigned
- Mar 18, 2010
- Last updated
- Mar 18, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 3111521345 | OR | Primary |
Addresses
Primary practice location
104 South Alder St.
Wallowa, OR 97885
Mailing address
P O Box 5
Wallowa, OR 97885
Phone (541) 886-3039
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3111521345 | OR | MD | Mental Illness Community Based Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268870400000",
"number": "1194049254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P O BOX 5",
"city": "WALLOWA",
"state": "OR",
"postal_code": "97885",
"telephone_number": "541-886-3039",
"fax_number": "541-886-3039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 SOUTH ALDER ST.",
"city": "WALLOWA",
"state": "OR",
"postal_code": "97885",
"telephone_number": "541-886-3039",
"fax_number": "541-886-3039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISBEY",
"first_name": "ANNE",
"middle_name": "M.",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-18",
"last_updated": "2010-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "OR",
"license": "3111521345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wallowa, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.