Active NPI
Wendi E Sullivan, RD
- Registered Dietitian
- Three Rivers, MI
National Provider Identifier
1417157603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 920895
- Practice address
- 701 S Health Pkwy
Three Rivers, MI 49093-8352 - Phone
- (269) 278-1145
- Fax
- (269) 273-9741
- NPI assigned
- Jul 25, 2007
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 920895 | MI | Primary |
Addresses
Primary practice location
701 S Health Pkwy
Three Rivers, MI 49093-8352
Mailing address
701 S Health Pkwy
Medical Staff Office
Three Rivers, MI 49093-8352
Phone (269) 273-9789
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0N99470 | Other | MI | MEDICARE GROUP NUMBER |
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 |
|---|---|---|---|
| 920895 | MI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214784000000",
"number": "1417157603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 S HEALTH PKWY",
"address_2": "MEDICAL STAFF OFFICE",
"city": "THREE RIVERS",
"state": "MI",
"postal_code": "490938352",
"telephone_number": "269-273-9789",
"fax_number": "269-273-9611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 S HEALTH PKWY",
"city": "THREE RIVERS",
"state": "MI",
"postal_code": "490938352",
"telephone_number": "269-278-1145",
"fax_number": "269-273-9741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "WENDI",
"middle_name": "E",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-25",
"last_updated": "2008-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MI",
"license": "920895",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "0N99470",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Three Rivers, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.