Maria-Gretchen Fabroa Wagner-Richardson, RN

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

251755-30 Issued in WI

Practice address

5735 Durand Ave
Mount Pleasant, WI 53406-5011

Phone

(262) 598-1392

NPI assigned

Feb 21, 2020

Last updated

Feb 21, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Quality Addiction Management Inc

  dba Kenosha Comprehensive Treatment Center

  • Methadone Clinic
  • Kenosha, WI
  • NPI 1184354979
  NPD (past)
• Quality Addiction Management Inc

  • Methadone Clinic
  • Green Bay, WI
  • NPI 1629282470
  NPD (past)

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

{
    "created_epoch": "1582243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1639702228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5735 DURAND AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534065011",
            "telephone_number": "262-598-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5735 DURAND AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534065011",
            "telephone_number": "262-598-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER-RICHARDSON",
        "first_name": "MARIA-GRETCHEN",
        "middle_name": "FABROA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-21",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "251755-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eliot Vildaver, DMD
• Village of Mount Pleasant (South Shore Consolidated Fire Department)
• Macey Lynn Villarreal, LCSW
• Vita Hearing Care, LLC (Vita Hearing Care)
• Kelly G. Von-Schilling Worth, DC, FIACN, DACAN
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2668)
• Wal-Mart Stores East LP (WalMart Pharmacy 10-5695)
• Brian Joseph Waldau, D.M.D.
• Sandra Lynn Waldvogel, COTA
• Walgreen

• Addiction (Substance Use Disorder) Registered Nurse in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Addiction (Substance Use Disorder) Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; 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.