Individual provider Active NPI

Innocent Wasike

  • Critical Care Medicine Registered Nurse
  • Santa Ana, CA
National Provider Identifier
1417717307
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine Registered NurseTaxonomy code 163WC0200X
License
95242296 Issued in CA
Practice address
550 N Flower St
Santa Ana, CA 92703-2361
Phone
(714) 647-4170
NPI assigned
Mar 19, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 95242296 CA Primary

Addresses

Primary practice location

550 N Flower St
Santa Ana, CA 92703-2361

Mailing address

1601 W Macarthur Blvd Apt 20D
Santa Ana, CA 92704-8218
Phone (714) 579-5392

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

State licenses

LicenseStateTypeSpecialty
95242296CAMDCritical Care Medicine Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1417717307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 W MACARTHUR BLVD APT 20D",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927048218",
            "telephone_number": "714-579-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 N FLOWER ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927032361",
            "telephone_number": "714-647-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASIKE",
        "first_name": "INNOCENT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "CA",
            "license": "95242296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.