Active NPI
Mary Beth Wertz, RN
- Administrator Registered Nurse
- Kankakee, IL
National Provider Identifier
1245587898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- 041.207211
- Practice address
- 100 N Jeffery Street
Kankakee, IL 60901 - Phone
- (815) 939-8501
- NPI assigned
- Aug 13, 2012
- Last updated
- Aug 13, 2012
- 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 |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 041.207211 | IL | Primary |
Addresses
Primary practice location
100 N Jeffery Street
Kankakee, IL 60901
Mailing address
817 N Prairie View Dr
Kankakee, IL 60901-7399
Phone (815) 370-9282
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 |
|---|---|---|---|
| 041.207211 | IL | MD | Administrator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344816000000",
"number": "1245587898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "817 N PRAIRIE VIEW DR",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609017399",
"telephone_number": "815-370-9282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N JEFFERY STREET",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "60901",
"telephone_number": "815-939-8501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WERTZ",
"first_name": "MARY",
"middle_name": "BETH",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-13",
"last_updated": "2012-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "IL",
"license": "041.207211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.