Active NPI
Kristine Wullenweber
- Day Training/Habilitation Specialist
- Flagstaff, AZ
National Provider Identifier
1629122726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Day Training/Habilitation Specialist
- License
- 706
- Practice address
- 11380 N Onika LN
Flagstaff, AZ 86004-5547 - Phone
- (928) 527-7992
- NPI assigned
- Jan 23, 2007
- Last updated
- Jul 9, 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 |
|---|---|---|---|---|
| Day Training/Habilitation Specialist | 373H00000X | 706 | AZ | Primary |
Addresses
Primary practice location
11380 N Onika LN
Flagstaff, AZ 86004-5547
Mailing address
11380 N Onika LN
Flagstaff, AZ 86004-5547
Phone (928) 527-7992
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 888547 | Medicaid | AZ |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1629122726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11380 N ONIKA LN",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860045547",
"telephone_number": "928-527-7992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11380 N ONIKA LN",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860045547",
"telephone_number": "928-527-7992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WULLENWEBER",
"first_name": "KRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "373H00000X",
"taxonomy_group": "",
"desc": "Day Training/Habilitation Specialist",
"state": "AZ",
"license": "706",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "888547",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
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.