Individual provider Active NPI

Catherine Henrickson

  • Diabetes Educator Registered Nurse
  • Two Rivers, WI
National Provider Identifier
1699210955
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diabetes Educator Registered NurseTaxonomy code 163WD0400X
License
76820-30 Issued in WI
Practice address
5300 Memorial Dr
Two Rivers, WI 54241-3923
Phone
(920) 794-5200
NPI assigned
Dec 22, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diabetes Educator Registered Nurse 163WD0400X 76820-30 WI Primary

Addresses

Primary practice location

5300 Memorial Dr
Two Rivers, WI 54241-3923

Mailing address

5300 Memorial Dr
Two Rivers, WI 54241-3923
Phone (920) 794-5200

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

LicenseStateTypeSpecialty
76820-30WIMDDiabetes Educator Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1482364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482364800000",
    "number": "1699210955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 MEMORIAL DR",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413923",
            "telephone_number": "920-794-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 MEMORIAL DR",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413923",
            "telephone_number": "920-794-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRICKSON",
        "first_name": "CATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-22",
        "last_updated": "2016-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "WI",
            "license": "76820-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Two Rivers, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; 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.