Haley Nicole Wanic, DNP, A-GNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704356520 Issued in MI

Practice address

14165 N Fenton Rd Ste 201a
Fenton, MI 48430-1584

Phone

(810) 853-5875

Fax

(586) 279-4515

NPI assigned

Jun 25, 2022

Last updated

Nov 10, 2022By 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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Westlake Consultation CenterGroup PAC ID 4284057662, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Westlake Consultation Center

  • Psychiatric/Mental Health Nurse Practitioner
  • Ann Arbor, MI
  • NPI 1962032227
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1656115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1689306052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14165 N FENTON RD STE 201A",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301584",
            "telephone_number": "108-535-8758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14165 N FENTON RD STE 201A",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301584",
            "telephone_number": "810-853-5875",
            "fax_number": "586-279-4515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANIC",
        "first_name": "HALEY",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DNP, A-GNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-25",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704356520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP (Vision Center 30-2693)
• Walgreen Co (Walgreens# 07065)
• Walsh Chiropractic & Wellness Center LLC
• Michael Thomas Walsh, D.C.
• Stephanie Walter
• Chavonna Michele Webb, PHARMD
• Alexis Marie Weber
• Anthony Joseph Weiss
• Matthew Jay Weiss, DO
• Michael Jacob Weiss, DC

• Nurse Practitioner in Fenton, MI
• Providers in Fenton, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.