Stephanie C Willett, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704288843 Issued in MI

Practice address

3770 Glenkerry CT
Portage, MI 49024-0700

Phone

(269) 329-2887

NPI assigned

Oct 7, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Michigan Pain Consultants PC

  • Interventional Pain Medicine Physician
  • Portage, MI
  • NPI 1538119391
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1285396267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3770 GLENKERRY CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240700",
            "telephone_number": "269-329-2887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3770 GLENKERRY CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240700",
            "telephone_number": "269-329-2887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLETT",
        "first_name": "STEPHANIE",
        "middle_name": "C",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-07",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704288843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Laptop",
            "affiliation": "N",
            "address_1": "3770 Glenkerry Ct",
            "city": "Portage",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490240700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kari Joy Wildner, LCSW
• Larry Wile
• John A Wiler, D.D.S.
• Allan J Wilke, MD
• Hunter Willard
• Erwin Willhite
• William J Alfieri D.C., P.C.
• Saundra Williams-Sulaiman
• Brittni Williams, DNP, PNP-BC
• David P Williams, O.D.

• Family Nurse Practitioner in Portage, MI
• Providers in Portage, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.