Active NPI
Jean F Wyman, NP
- Gerontology Nurse Practitioner
- Minneapolis, MN
National Provider Identifier
1386738995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- R 138190-6
- Practice address
- Dept of OB/GYN & Women'S Health
420 Delaware Street SE MMC 395
Minneapolis, MN 55455 - Phone
- (763) 782-6400
- Fax
- (763) 782-9558
- NPI assigned
- Oct 3, 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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | R 138190-6 | MN | Primary |
Addresses
Primary practice location
Dept of OB/GYN & Women'S Health
420 Delaware Street SE MMC 395
Minneapolis, MN 55455
Mailing address
University of Minnesota Physicians
420 Delaware St SE Mmc292
Minneapolis, MN 55455
Phone (763) 782-6400
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04-08300 | Other | MN | MEDICA - CHOICE |
| B612 | Other | MN | CHAMPUS |
| 502K7WY | Other | MN | BCBS |
| 04-04568 | Other | MN | MEDICA - PRIMARY |
| HP27464 | Other | MN | HEALTHPARTNERS |
| 2378192 | Other | MN | ARAZ |
| 41262700 | Medicaid | WI | |
| 0715078 | Medicaid | IA | |
| 1019243 | Other | MN | PREFERRED ONE |
| 123361 | Other | MN | UCARE |
| 4305977 | Medicaid | MT | |
| 84536-2 | Other | MN | FAIRVIEW CAREGIVE |
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 138190-6 | MN | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386738995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "UNIVERSITY OF MINNESOTA PHYSICIANS",
"address_2": "420 DELAWARE ST SE MMC292",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "763-782-6400",
"fax_number": "763-782-9558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "DEPT OF OB/GYN & WOMEN'S HEALTH",
"address_2": "420 DELAWARE STREET SE MMC 395",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "763-782-6400",
"fax_number": "763-782-9558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYMAN",
"first_name": "JEAN",
"middle_name": "F",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "MN",
"license": "R 138190-6",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA - CHOICE",
"identifier": "04-08300",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "B612",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "502K7WY",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA - PRIMARY",
"identifier": "04-04568",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP27464",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "2378192",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41262700",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0715078",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1019243",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "123361",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4305977",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FAIRVIEW CAREGIVE",
"identifier": "84536-2",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
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.