Active NPI
Mary Wickenheiser, RN
- Registered Nurse
- Ypsilanti, MI
National Provider Identifier
1679098966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4704323822
- Practice address
- 555 Towner St
Ypsilanti, MI 48198-5752 - Phone
- (734) 544-3000
- Fax
- (734) 544-6732
- NPI assigned
- Aug 8, 2017
- 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 | 4704323822 | MI | Primary |
Addresses
Primary practice location
555 Towner St
Ypsilanti, MI 48198-5752
Mailing address
555 Towner St
Ypsilanti, MI 48198-5752
Phone (734) 544-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245303890 | Medicaid | MI |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704323822 | MI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523836800000",
"number": "1679098966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 TOWNER ST",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481985752",
"telephone_number": "734-544-3000",
"fax_number": "734-544-6732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 TOWNER ST",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481985752",
"telephone_number": "734-544-3000",
"fax_number": "734-544-6732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKENHEISER",
"first_name": "MARY",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-08",
"last_updated": "2018-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704323822",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1245303890",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ypsilanti, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.