Active NPI
Donna Mae Whitehead, RN
- General Practice Registered Nurse
- Manitowoc, WI
National Provider Identifier
1346207107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- Practice address
- 5140 Expo Dr
# 108
Manitowoc, WI 54220-8336 - Phone
- (920) 684-5460
- Fax
- (920) 684-5460
- NPI assigned
- Apr 26, 2006
- 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 | WI | Primary |
Addresses
Primary practice location
5140 Expo Dr
# 108
Manitowoc, WI 54220-8336
Mailing address
5140 Expo Dr
# 108
Manitowoc, WI 54220-8336
Phone (920) 684-5460
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38332700 | Medicaid | WI |
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 |
|---|---|---|---|
| 150620-030 | WI | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1346207107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5140 EXPO DR",
"address_2": "# 108",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542208336",
"telephone_number": "920-684-5460",
"fax_number": "920-684-5460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5140 EXPO DR",
"address_2": "# 108",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542208336",
"telephone_number": "920-684-5460",
"fax_number": "920-684-5460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITEHEAD",
"first_name": "DONNA",
"middle_name": "MAE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-26",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "WI",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38332700",
"state": "WI"
}
],
"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 Jul 9, 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.