Active NPI
Joan Mary Cloutier, RN
- General Practice Registered Nurse
- Traverse City, MI
National Provider Identifier
1235772385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- License
- 4704192100
- Practice address
- 3205 Supply Rd
Traverse City, MI 49696-9486 - Phone
- (231) 649-0099
- Fax
- (231) 935-1496
- NPI assigned
- Oct 22, 2019
- 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 |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 4704192100 | MI | Primary |
Addresses
Primary practice location
3205 Supply Rd
Traverse City, MI 49696-9486
Mailing address
1501 Cass St
Traverse City, MI 49684-4157
Phone (231) 649-0099
Other practice location 1
1501 Cass St
Traverse City, MI 49684-4157
Phone (236) 164-9009
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | neurorestorative.com | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| 4704192100 | MI | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571702400000",
"number": "1235772385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 CASS ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496844157",
"telephone_number": "231-649-0099",
"fax_number": "231-935-1496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3205 SUPPLY RD",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496969486",
"telephone_number": "231-649-0099",
"fax_number": "231-935-1496"
}
],
"practiceLocations": [
{
"address_1": "1501 Cass St",
"address_purpose": "LOCATION",
"city": "Traverse City",
"state": "MI",
"postal_code": "496844157",
"country_code": "US",
"telephone_number": "236-164-9009",
"fax_number": "231-935-1496",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLOUTIER",
"first_name": "JOAN",
"middle_name": "MARY",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-22",
"last_updated": "2019-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "MI",
"license": "4704192100",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "neurorestorative.com",
"affiliation": "N",
"endpointDescription": "work email",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Medical",
"address_1": "3205 Supply Rd",
"city": "Traverse City",
"state": "MI",
"country_code": "US",
"postal_code": "496969486",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.