Active NPI
Lorijean Marjorie Mettetal, FNP-C
- Nurse Practitioner
- Manitowoc, WI
National Provider Identifier
1336491430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 6919-33
- Practice address
- 601 Buffalo St
Lakeshore Community Health Clinic
Manitowoc, WI 54220-6817 - Phone
- (423) 975-2200
- NPI assigned
- Oct 12, 2012
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 6919-33 | WI | Primary |
Addresses
Primary practice location
601 Buffalo St
Lakeshore Community Health Clinic
Manitowoc, WI 54220-6817
Mailing address
601 Buffalo St
Lakeshore Community Health Center
Manitowoc, WI 54220-6817
Phone (423) 483-2192
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6919-33 | WI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472774400000",
"number": "1336491430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 BUFFALO ST",
"address_2": "LAKESHORE COMMUNITY HEALTH CENTER",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542206817",
"telephone_number": "423-483-2192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 BUFFALO ST",
"address_2": "LAKESHORE COMMUNITY HEALTH CLINIC",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542206817",
"telephone_number": "423-975-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "METTETAL",
"first_name": "LORIJEAN",
"middle_name": "MARJORIE",
"name_prefix": "Ms.",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-12",
"last_updated": "2016-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "6919-33",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.