Individual provider Active NPI

Patricia Sue Beierwaltes, CPNP

  • Pediatric Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1336299767
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
4704139472 Issued in MI
Practice address
Children'S Hospital of Michigan
3901 Beaubien Blvd.
Detroit, MI 48201
Phone
(313) 745-5226
Fax
(313) 745-2405
NPI assigned
Jan 10, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 4704139472 MI Primary

Addresses

Primary practice location

Children'S Hospital of Michigan
3901 Beaubien Blvd.
Detroit, MI 48201

Mailing address

750 Lakepointe St
Grosse Pointe Park, MI 48230-1706
Phone (313) 745-0396

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)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704139472MIMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Pediatricians Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336299767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 LAKEPOINTE ST",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301706",
            "telephone_number": "313-745-0396",
            "fax_number": "313-745-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CHILDREN'S HOSPITAL OF MICHIGAN",
            "address_2": "3901 BEAUBIEN BLVD.",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-745-5226",
            "fax_number": "313-745-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEIERWALTES",
        "first_name": "PATRICIA",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704139472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.