Individual provider Active NPI

Jennifer Lee Wetteland, PA-C

  • Physician Assistant
  • McHenry, IL
National Provider Identifier
1396804282
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4805 Prime Pkwy
McHenry, IL 60050-7002
Phone
(815) 363-9500
Fax
(815) 363-9696
NPI assigned
Dec 6, 2006
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
Physician Assistant 363A00000X IL Primary

Addresses

Primary practice location

4805 Prime Pkwy
McHenry, IL 60050-7002

Mailing address

4805 Prime Pkwy
McHenry, IL 60050-7002
Phone (815) 363-9500

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085-002543ILMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: jennifer.wetteland.p37@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p32@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p36@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p6@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p34@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p40@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p50@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p13@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p28@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p2@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p30@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p27@direct.medcor.nextgenshare.com
  • Direct secure messaging: jennifer.wetteland.p56@direct.medcor.nextgenshare.com

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396804282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4805 PRIME PKWY",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507002",
            "telephone_number": "815-363-9500",
            "fax_number": "815-363-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 PRIME PKWY",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507002",
            "telephone_number": "815-363-9500",
            "fax_number": "815-363-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WETTELAND",
        "first_name": "JENNIFER",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

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.