Active NPI
Patricia Willeman
- Clinical Exercise Physiologist
- Amery, WI
National Provider Identifier
1205105400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Exercise Physiologist
- License
- 1000438
- Practice address
- 265 Griffin St E
Amery, WI 54001-1439 - Phone
- (715) 268-0290
- NPI assigned
- Dec 19, 2011
- 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 |
|---|---|---|---|---|
| Clinical Exercise Physiologist | 224Y00000X | 1000438 | WI | Primary |
Addresses
Primary practice location
265 Griffin St E
Amery, WI 54001-1439
Mailing address
265 Griffin St E
Amery, WI 54001-1439
Phone (715) 268-0290
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 |
|---|---|---|---|
| 1000438 | WI | MD | Clinical Exercise Physiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324252800000",
"number": "1205105400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "265 GRIFFIN ST E",
"city": "AMERY",
"state": "WI",
"postal_code": "540011439",
"telephone_number": "715-268-0290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "265 GRIFFIN ST E",
"city": "AMERY",
"state": "WI",
"postal_code": "540011439",
"telephone_number": "715-268-0290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLEMAN",
"first_name": "PATRICIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-19",
"last_updated": "2011-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "224Y00000X",
"taxonomy_group": "",
"desc": "Clinical Exercise Physiologist",
"state": "WI",
"license": "1000438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amery, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.