Active NPI
Patricia M Wilber, CST
- Surgical Technologist
- Lafayette, IN
National Provider Identifier
1710501002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 107477
- Practice address
- 3930 Mezzanine Dr Ste D
Lafayette, IN 47905-8646 - Phone
- (765) 807-2784
- Fax
- (765) 807-2786
- NPI assigned
- Jun 2, 2020
- 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 |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 107477 | Primary |
Addresses
Primary practice location
3930 Mezzanine Dr Ste D
Lafayette, IN 47905-8646
Mailing address
PO Box 4699
Lafayette, IN 47903-4699
Phone (765) 446-5417
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591056000000",
"number": "1710501002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4699",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479034699",
"telephone_number": "765-446-5417",
"fax_number": "765-446-5317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3930 MEZZANINE DR STE D",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479058646",
"telephone_number": "765-807-2784",
"fax_number": "765-807-2786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILBER",
"first_name": "PATRICIA",
"middle_name": "M",
"credential": "CST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-02",
"last_updated": "2020-06-02",
"certification_date": "2020-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": null,
"license": "107477",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.