Active NPI
Carmen Lee Wallington
- Registered Nurse
- Detroit, MI
National Provider Identifier
1639423882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4704278833
- Practice address
- 79 W Alexandrine St
Suite 3810
Detroit, MI 48201-2015 - Phone
- (313) 446-8880
- Fax
- (313) 446-8889
- NPI assigned
- Nov 8, 2012
- 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 Nurse | 163W00000X | 4704278833 | MI | Primary |
Addresses
Primary practice location
79 W Alexandrine St
Suite 3810
Detroit, MI 48201-2015
Mailing address
79 W Alexandrine St
Suite 3810
Detroit, MI 48201-2015
Phone (313) 446-8880
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4704278833 | MI | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Detroit Health Care for the Homeless | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Warren, MI
- NPI 1144371279
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352332800000",
"number": "1639423882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 W ALEXANDRINE ST",
"address_2": "SUITE 3810",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012015",
"telephone_number": "313-446-8880",
"fax_number": "313-446-8889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 W ALEXANDRINE ST",
"address_2": "SUITE 3810",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012015",
"telephone_number": "313-446-8880",
"fax_number": "313-446-8889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLINGTON",
"first_name": "CARMEN",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-08",
"last_updated": "2012-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704278833",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.